Prevalence of Esophageal Eosinophilia Varies by Climate Zone in the United States

Hurrell, Jennifer; Genta, Robert M.; Dellon, Evan S.

doi:10.1038/ajg.2012.6

Cited by 98 publications

(72 citation statements)

References 48 publications

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“…This is further supported by the observation that EoE varies by climate zones in the USA [63]. A confirmation of a seasonal dependency of EoE would be an indicator that external seasonal factors (especially pollen) could play a substantial role in the pathogenesis of this Th2-type inflammation.…”

Section: Eoe and Seasonal Distributionsupporting

confidence: 57%

Epidemiology of Eosinophilic Esophagitis

Hrúz¹

2014

Dig Dis

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Eosinophilic esophagitis (EoE) is an allergy-associated disease defined clinically by esophagus-related symptoms in combination with a dense esophageal eosinophilia, both of which are unresponsive to prolonged acid suppression with proton pump inhibitors. Over the last two decades EoE has increasingly been recognized in various geographical areas (mostly industrialized countries) with high socioeconomic development. The prevalence rate is increasing and reaches up to 50 patients per 100,000 inhabitants in some indicator regions. Whether this increased prevalence is due to a real increase in incidence, a result of increased awareness by health care providers or because of the nonfatal nature of EoE adding more and more cases to the patient pool is still a matter of controversy. Several studies have consistently demonstrated a male predominance in EoE, with a male-to-female risk ratio of 3:1. The average age at diagnosis ranges between 30 and 50 years and suggests that EoE is a disease of the middle-aged man. It can affect patients of every race, but the disease is more common among Caucasians. In both children and adults, EoE has been clearly associated with allergies to food and aeroallergens, and most EoE patients present with a personal allergic background (e.g. asthma, rhinoconjunctivitis or oral allergy syndrome). In conclusion, knowledge of epidemiologic parameters of EoE is crucial for identifying risk factors as well as pathogenic mechanisms, planning preventive measures and determining optimal treatment strategies.

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Section: Eoe and Seasonal Distributionsupporting

confidence: 57%

Epidemiology of Eosinophilic Esophagitis

Hrúz¹

2014

Dig Dis

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“…26,27 Given the similarity in geographic locale to Olmsted County, Minnesota, and thus the likelihood that environmental factors would be relatively similar, we had postulated that our results would be supportive of previous findings. 17 Hurrel et al 28 had demonstrated that EoO has the highest prevalence in the cold and arid zones. However, unlike these studies conducted in the similar climate environments, we did not find an increased monthly or seasonal incidence in our population.…”

Section: Discussionmentioning

confidence: 99%

Lack of seasonal variation in the incidence of eosinophilic oesophagitis in adolescent and adult non‐PPI‐responsive oesophageal eosinophilia midwestern US populations

et al. 2014

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Background: Eosinophilic oesophagitis (EoO) has been associated with allergic disorders as well as aeroallergens. The current literature has shown a possible association between seasonal variation, mainly in the spring, and the incidence of EoO. However, this data was based on small population studies that did not exclude proton-pump inhibitor (PPI)-responsive oesophageal eosinophilia (PPI-ROE) in their cohort. Aim: The aim of this study was to determine if there is a seasonal variation associated with the diagnosis of EoO in patients that had been treated with high-dose PPI prior to diagnosis. Methods: Oesophageal biopsies were obtained from a cohort of patients who presented with symptoms of dysphagia, odynophagia, and heartburn during a 10-year period. Symptomatic patients who had biopsies from the mid and distal oesophagus with !20 eosinophils per high-power field (hpf) while on high-dose PPI treatment for at least 5 weeks were diagnosed as having EoO. The monthly and seasonal incidences were determined (winter, January-March; spring, AprilJune; summer, July-September; Autumn, October-December). Results: A total of 20,718 patients were identified and their records evaluated. From this cohort, 193 (0.93%) symptomatic patients had biopsy-proven oesophageal eosinophilia (!20 eosinophils/hpf) and no seasonal variation was seen in this group. However, only 57 (0.28%) had been adequately treated with PPI prior to diagnosis (i.e. non-PPI-ROE biopsy-proven EoO; !20 eosinophils/hpf: 39 males, 18 females; age 29.5 years). The most common medical history components included asthma (12.3%) and food allergies (3.5%), and the most common presenting symptoms included dysphagia (50.9%) and heartburn (26.3%). The monthly and seasonal incidences in our cohort were with no apparent trend (p ¼ 0.713 and 0.703, respectively). Conclusions: The incidence of EoO was consistent across all 12 months as well as during the four seasons. Our data does not support a seasonal variation in relation to the incidence of EoO in the US midwestern non-PPI-ROE population.

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“…25,26 There is seasonal and geographic variation in frequency, with higher rates reported in the summer and early fall 22 and in cold and arid zones. 27 These temporal and geographic trends likely represent the putative atopic etiology of EoE.…”

Section: Demographicsmentioning

confidence: 99%