Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multi-Center Patient Population from the Consortium for Food Allergy Research

Publication date: Available online 1 August 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Mirna Chehade, Stacie M. Jones, Robbie D. Pesek, A. Wesley Burks, Brian P. Vickery, Robert A. Wood, Donald Y.M. Leung, Glenn T. Furuta, David M. Fleischer, Alice K. Henning, Peter Dawson, Robert W. Lindblad, Scott H. Sicherer, J. Pablo Abonia, Joseph D. Sherrill, Hugh A. Sampson, Marc E. Rothenberg

Abstract

Background

Eosinophilic esophagitis (EoE) is increasingly common, but data on phenotypic aspects are still incomplete.

Objectives

To describe the clinical, endoscopic and histopathological features of a large number of children and adults with EoE across the US.

Methods

This was a multi-site single visit registry enrolling subjects aged 6 months-65 years with EoE. Participants provided responses regarding their medical history, with verification of the diagnosis and history by the study teams.

Results

705 subjects were analyzed (median [IQR] age at enrollment 11.2 [6.7-17.7] years, 68.2% male, 87.9% whites). 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/immunological 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 ∼10% of EoE patients; the symptom-diagnosis time gap is influenced by age, race, food allergy and atopic dermatitis; symptoms vary with race; concurrent infectious/immunological disorders and mental health disorders are common; and the level of esophageal eosinophils is comparable in patients with and without fibrostenotic features.