The prevalence of oesophageal eosinophilia and eosinophilic oesophagitis: a prospective study in unselected patients presenting to endoscopy

Authors

  • R. J. Sealock,

    1. Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    2. The Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • J. R. Kramer,

    1. Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    2. The Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
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  • G. Verstovsek,

    1. Department of Pathology, Baylor College of Medicine, Houston, TX, USA
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  • P. Richardson,

    1. Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    2. The Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
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  • M. Rugge,

    1. Surgical Pathology & Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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  • P. Parente,

    1. Casa Sollievo della Sofferenza, Department of Pathology, San Giovanni Rotondo, Italy
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  • M. Vela,

    1. The Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • H. B. El-Serag

    Corresponding author
    1. The Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    2. Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    • Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Correspondence to:

Dr H. B. El-Serag, VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA.

E-mail: hasheme@bcm.tmc.edu

Summary

Background

Oesophageal eosinophilia (EE) is encountered in clinical practice as oesophageal biopsies are being obtained in patients with GI symptoms other than classical symptoms of eosinophilic oesophagitis (EoE). The prevalence, determinants and clinical relevance of EE identified irrespective of symptoms are unclear.

Aim

To determine the prevalence and risk factors of EE with or without EoE in a nonselected group of patients undergoing endoscopy and in primary care patients.

Methods

A cross-sectional study in a single VA centre in which we obtained at least one oesophageal biopsy from patients presenting to elective endoscopy, as well as a sample of patients eligible for screening colonoscopy recruited from primary care clinics. EE was defined by >15 eosinophils in a single HPF; and EoE was defined as definite, probable or none depending on the presence of EE, acid-suppressive therapy and oesophageal symptoms.

Results

EE was identified in 33 of 1357 patients (2.4%, 95% CI: 1.7–3.4); of whom 9 had definite EoE (0.66%, 95% CI: 0.23–1.10), 17 had probable EoE (1.25%), and the only 7 patients had EE without EoE. The prevalence of EE was 2.3% among patients undergoing elective endoscopy and 0.1% among patients eligible for screening colonoscopy. Seasonal allergies (adjusted OR: 2.78; 95% CI: 1.26–6.11) and oesophageal strictures (4.50; 0.90–22.40) were associated with EE.

Conclusions

The prevalence of EE was 2.3% among unselected patients presenting to endoscopy most of whom have EoE. EE was present in 0.1% in primary care patients none of whom had EoE.

Ancillary