Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multicenter Patient Population from the Consortium for Food Allergy Research.
2018 Sep - Oct
Journal Article
Authors:
Chehade, M.;
Jones, S.M.;
Pesek, R.D.;
Burks, W.;
Vickery, B.P.;
Wood, R.A.;
Leung, D.Y.M.;
Furuta, G.T.;
Fleischer, D.M.;
Henning, A.K.;
Dawson, P.;
Lindblad, R.W.;
Sicherer, S.H.;
Abonia, P.;
Sherrill, J.D.;
Sampson, H.A.;
Rothenberg, M.E.
Secondary:
J Allergy Clin Immunol Pract
Volume:
6
Pagination:
1534-1544.e5
Issue:
5
PMID:
30075341
DOI:
10.1016/j.jaip.2018.05.038
Keywords:
Adolescent; Adult; Aged; Biomedical Research; Child; Endoscopy; Eosinophilic Esophagitis; Eosinophils; Esophagus; Female; Food Hypersensitivity; Humans; Male; Middle Aged; Phenotype; Population Groups; United States; Young Adult
Abstract:
BACKGROUND: Eosinophilic esophagitis (EoE) is increasingly common, but data on phenotypic aspects are still incomplete.OBJECTIVES: To describe the clinical, endoscopic, and histopathologic features of a large number of children and adults with EoE across the United States.METHODS: This was a multisite single visit registry enrolling subjects aged 6 months to 65 years with EoE. Participants provided responses regarding their medical history, with verification of the diagnosis and history by the study teams.RESULTS: A total of 705 subjects were analyzed (median [interquartile range] age at enrollment 11.2 [6.7-17.7] years, 68.2% male, 87.9% whites). Of these, 67 subjects had concurrent gastrointestinal eosinophilia, with gastric mucosa most common. An age- and race-dependent time gap was present between symptom onset and time of diagnosis (adults and whites with longer gap). Food allergy and atopic dermatitis were associated with a decrease in this gap. Symptoms varied with age (more dysphagia and food impaction in adults) and with race (more vomiting in non-whites). Esophageal rings and strictures at diagnosis were more common in adults, although esophageal eosinophilia was comparable among age groups. Concomitant allergic disease (91%), infectious/immunologic disorders (44%), neurodevelopmental disorders (30%), and failure to thrive (21%) were common. Depression/anxiety increased with age. EoE was reported in 3% of parents and 4.5% of siblings.CONCLUSIONS: Gastrointestinal eosinophilia is present in approximately 10% of patients with EoE; the symptom-diagnosis time gap is influenced by age, race, food allergy, and atopic dermatitis; symptoms vary with race; concurrent infectious/immunologic disorders and mental health disorders are common; and the level of esophageal eosinophils is comparable in patients with and without fibrostenotic features.
