Eosinophilic oesophagitis in patients presenting with dysphagia – a prospective analysis

• Published in: Alimentary pharmacology & therapeutics Vol. 28; no. 9; pp. 1140 - 1146
• Main Authors: MACKENZIE, S. H., GO, M., CHADWICK, B., THOMAS, K., FANG, J., KUWADA, S., LAMPHIER, S., HILDEN, K., PETERSON, K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2008; Blackwell
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Deglutition Disorders - etiology; Deglutition Disorders - pathology; Digestive system; Eosinophilia - complications; Eosinophilia - pathology; Esophagitis - complications; Esophagitis - pathology; Esophagoscopy - methods; Esophagus; Esophagus - pathology; Esophagus - physiopathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hematologic and hematopoietic diseases; Humans; Male; Medical sciences; Middle Aged; Other diseases. Hematologic involvement in other diseases; Other diseases. Semiology; Pharmacology. Drug treatments; Prospective Studies; Risk Factors; Statistics as Topic; Young Adult; Prospective; Esophageal disease; Esophagitis; Digestive diseases; Hemopathy; Dysphagia; Swallowing; Hypereosinophilic syndrome
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2008.03795.x

Summary Background  Eosinophilic oesophagitis (EoO) may be a common finding in adults presenting with dysphagia. Aim  To identify the risk factors and prevalence of EoO in an adult population with dysphagia. Methods  All patients with dysphagia referred for an upper endoscopy (EGD) were asked to participate. Patients completed a detailed questionnaire followed by EGD with four quadrant biopsies in the distal and mid‐oesophagus. Primary endpoint was the prevalence of EoO; secondary endpoints included age, gender, asthma, food allergies, gastro‐oesophageal reflux disease/dysphagia score and endoscopic findings. Results  Two hundred and sixty‐one patients enrolled between December 2005 and January 2007. Thirty‐one patients (12%) met pathological criteria for EoO. There was no difference in EoO prevalence within each gender. Mean age of EoO patients was 42 ± 15 vs. 61 ± 15 for non‐EoO patients (P < 0.001). EoO was diagnosed in 35% of patients <50 years of age. EoO was present in 22% of asthmatics vs. 9% non‐asthmatics (P < 0.01). EoO was present in 36.8% of patients with self‐reported food allergies vs. 9.3% those without allergy (P < 0.001). A 13/31(42%) of EoO patients did not have the classic EGD findings (rings ± furrows) and would have been missed without oesophageal biopsies. Conclusions  Eosinophilic oesophagitis was diagnosed in 12% of the patients presenting with dysphagia with relative risk of 9.5 if age <50 years. Oesophageal biopsies are warranted in patients presenting with dysphagia especially in the younger population. Patients may not present with classic endoscopic findings and EoO can be missed without biopsies.