Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course

Abstract

SUMMARYEosinophilic esophagitis is a chronic immune-mediated esophageal disorder. For its timely diagnosis, clinicians must recognize common symptoms, and understand differences in symptoms across patient groups. The aim of this study is to systematically review the epidemiology and natural history of eosinophilic esophagitis. The MEDLINE, Embase, and Cochrane databases were searched from 1974 to February 2017 for studies describing the epidemiology and natural history of eosinophilic esophagitis. Congress abstracts from 2014 to 2016 were also searched. Search results were screened against predetermined inclusion/exclusion criteria by two independent reviewers, and data extraction was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 1376 articles identified, 47 met the inclusion criteria: 20 on epidemiology and 27 on natural history. Incidence and prevalence of eosinophilic esophagitis varied widely across North America and Europe, and increased over time. Incidence increased 131-fold in the Netherlands (1996–2010), 20-fold in Denmark (1997–2006), and 5.1-fold in Calgary, Canada (2004–2008). The most commonly reported symptoms were emesis and abdominal pain in children, and dysphagia and food impaction in adults. Age at diagnosis was 5.9–12.0 years in children, and approximately 30 years in adults. Time between symptom onset and diagnosis was 1.2–3.5 years in children and 3.0–8.0 years in adults. Diagnostic delay was associated with an increased risk of endoscopic features of fibrostenosis. Symptoms of eosinophilic esophagitis differed significantly by age and race. In conclusion, there is an increasing incidence and prevalence of eosinophilic esophagitis. The considerable delay between symptom onset and diagnosis suggests that clinicians do not readily recognize the disease, which may have important clinical ramifications.

Systematic review with meta‐analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population‐based studies

“…The time at which each study was developed, differences in the threshold of eosinophil count defining EoE and in how patients with a response to proton pump inhibitors (PPIs) were considered, as well as regional variations, are the most relevant explanations for the broad range of incidence and prevalence provided by this systematic review. The recent consideration that patients who respond to PPIs are within the spectrum of the disease rather than considered a different entity, along with new data available from 2018 that provides the highest frequency for the disease reported so far (and not included in recent reviews), makes the previously reported prevalence and incidence figures outdated.…”

High‐fat diet‐induced obesity worsens TH2 immune response and immunopathologic characteristics in murine model of eosinophilic oesophagitis

“…The predominant EoE clinical symptoms are dysphagia, feeding dysfunction, food impaction, abdominal pain and vomiting. Those symptoms may vary with age, sex and race of the patient . Clinical and epidemiological studies indicate EoE is an allergic disease, which develops due to multifactorial interplay of genetic, immunological and environmental factors.…”

“…In addition, T H 2 cells are also responsible for IL‐13 and IL‐5 production, which induce the proliferation and survival of eosinophils, in the oesophageal epithelial layer, in response to food allergen intake . In that sense, the presence of 15 eosinophils, or more, per high power field (≥15 eos/HPF), in at least one biopsy sample, differentiates EoE from gastroesophageal reflux disease (GERD), as they present symptoms overlap . In association with the increased eosinophilia, clinical studies have shown mast cells to accumulate in oesophageal mucosa .…”

Association between endoscopic findings and histopathological confirmation in patients with suspicion of eosinophilic esophagitis

“…Studies in adults have reported that the peak incidence occurs between 30 and 50 years (8,9) . With regard to gender, the literature shows a higher prevalence in males (3) . Despite the higher prevalence of females in our study, we observed an equality (1:1) in the analysis of the group with positive biopsy, however with no statistical significance.…”

“…EoE is more common in males and can affect all age groups, with peak prevalence in adults between 30 and 50 years. The incidence (1 to 20 new cases per 100,000 inhabitants per year) and the prevalence (13 to 49 cases per 100,000 inhabitants per year) of the disease vary widely in North America and in Europe and has increased dramatically over the years (2,3) .…”