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Eosinophilic Esophagitis in Adults

Is It Really a Rare Disease?

12

Kethu, Sripathi R., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S26–S27
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Division of Gastroenterology, Brown Medical School and Rhode Island Hospital, Providence, RI.

Purpose: Eosinophilic esophagitis (EE) is increasingly recognized as an important cause of dysphagia in adults. However, the true prevalence of EE in adult patients who present with dysphagia is unknown. The aim of the present study was to estimate the frequency of EE as the underlying cause of dysphagia in adults.

Methods: All patients who underwent upper endoscopy by a single gastroenterologist for the evaluation of dysphagia over an 18-month period (Oct 2003 to Mar 2005) were included in the study. Because of the increasing reports of EE in the recent literature, esophageal biopsies were obtained routinely in patients who had no anatomic abnormality that could explain the cause of dysphagia and/or if they had any features suggestive of eosinophilic esophagitis (mucosal furrows, corrugations, adherent whitish plaques, fragile esophageal mucosa or so called crepe-paper mucosa). Two random biopsy samples are taken at each level, from the mid and lower esophagus. The diagnosis of eosinophilic esophagitis was based on the presence of >24 eosinophils per high power field.

Results: A total of 454 upper endoscopies were performed during the study period. Thirty-eight patients underwent upper gastrointestinal endoscopy for the evaluation of dysphagia. No apparent anatomical abnormality was found in 16 of them (42%), 10 male and 6 female. Five of these patients (all white male, age range:18–49, mean age:31) were found to have EE; these patients constituted 13% of the total patients who were evaluated for dysphagia. Two of the 5 patients had peripheral eosinophilia (40%). No cause for dysphagia was found in 28% of patients after the endoscopy and esophageal biopsies. In subgroup analysis, among men who had no obvious anatomic abnormality such as a stricture, schatzki's ring, cancer, or esophagitis that could be the source of their symptoms, 5 out of 10 patients (50%) had biopsies diagnostic of EE.

Conclusions: EE should no longer be considered a rare cause of dysphagia in adults. Routine esophageal biopsies should be performed in patients with dysphagia who have no obvious endoscopic anatomical abnormalities that could explain their dysphagia, especially if they are male. If these findings are confirmed in large prospective studies, increased awareness of eosinophilic esophagitis in adults will likely avoid unnecessary further investigations after a “negative” upper endoscopy.

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