411 Association of Eosinophilic Esophagitis With Allergic-Immunologic Conditions: A Population-Based National Study

Abstract

INTRODUCTION: Eosinophilic esophagitis (EoE) and asthma are two common chronic conditions that are closely related and likely mediated by similar immunopathologic mechanisms and can be treated with similar treatment modalities. We aimed to examine the association of EoE with asthma using a large nationwide hospital database. We additionally examined the association of EoE with other related allergic-immunologic conditions such as allergic urticaria, eczema, allergic conjunctivitis, allergic rhinitis, and food and environmental allergies. METHODS: Data were obtained from a commercial de-identified patient database (Explorys, IBM, Inc.) that integrates electronic health records from 26 major U.S. hospital systems from 1999 to June 2019. Inclusion criteria for cases was all patients with a Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) diagnosis of asthma whereas inclusion criteria for controls was patients without asthma. Odds ratios (OR) and confidence intervals (CI) were calculated for the association of EoE with asthma and other related allergic-immunologic conditions. RESULTS: A total of 3,459,740 cases had asthma. Out of these, 4,490 had a diagnosis of EoE which followed in time the diagnosis of asthma. Out of 33,336,680 controls without asthma in the database, 20,390 had a diagnosis of EoE. When compared to controls without asthma, cases with asthma had a 2 (95% CI = 2.06 - 2.19) times higher odds of receiving a diagnosis of EoE following their asthma diagnosis. Similarly, other allergic-immunologic conditions were associated with a much higher odds of having EoE (Table 1). Patients with severe asthma had a 1.75 (CI = 1.37 - 2.23) times greater odds of having EoE when compared to patients with less severe (i.e. mild or moderate) asthma. CONCLUSION: There is a higher tendency for EoE to be diagnosed in patients with asthma and other allergic-immunologic conditions. In addition to being a retrospective analysis, inability to fully validate SNOMED-CT codes and unavailability of histology for the diagnosis of EoE could limit generalizability of the study. Nevertheless, patients with pre-existing asthma or allergic-immunologic conditions and symptoms suggestive of EoE (dysphagia, acid reflux or feeding difficulties) may warrant endoscopic evaluation.