An In-Depth Characterization of a Large Cohort of Adults Patients with Eosinophilic Esophagitis

Publication date: Available online 14 September 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Lyvia Y. Leigh, Jonathan M. Spergel

Abstract

BACKGROUND

Eosinophilic esophagitis (EoE) is a chronic allergic, immune-mediated disease associated with increased risk of comorbid atopic conditions.

OBJECTIVE

We aim to perform an in-depth characterization of a large cohort of manually verified adult EoE patients including evaluation of less studied associations such as pollen food allergy syndrome, anaphylaxis, autoimmunity and psychiatric comorbidities.

METHODS

We performed manual retrospective electronic medical record review of 1,218 patients with EoE identified by ICD-9 and 10 codes from the University of Pennsylvania Health Systems (UPHS). Through manual chart review, we evaluated patient demographics; family and smoking history; laboratory and endoscopic findings; treatment; and comorbid atopic, autoimmune, and psychiatric conditions.

RESULTS

950 out of 1,218 patients had biopsy-proven EoE. This cohort was predominantly male, Caucasian, never-smokers who presented most commonly with dysphagia with an initial biopsy showing 49 Eos/HPF, serum absolute eosinophilic count of 446, and average total IgE of 243. 55% had impaction (of which 38% required endoscopic removal), 56% had strictures/fibrosis (of which 56% underwent dilatation). Therapy used was predominantly (77%) medical only. Comorbid atopy, pollen food allergy syndrome, drug allergy, anaphylaxis, autoimmunity, and psychiatric illnesses were higher in the EoE cohort compared with the general UPHS population.

CONCLUSION

Our adult cohort of manually verified, biopsy-proven EoE showed increased risk of pollen food allergy syndrome, anaphylaxis, and comorbid autoimmune and psychiatric conditions compared with the UPHS population. There was also an increased prevalence of impaction and stricture/fibrosis requiring endoscopic intervention compared with the pediatric population.

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