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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:
<p>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.</p>

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