Eosinophilic esophagitis is a chronic immune-mediated inflammatory condition characterized by eosinophils infiltrating the esophagus occurring in 1 in 2,000 individuals. Since the 1990’s its incidence has been increasing and it is the most common cause of chronic swallowing problems in the developed world.
It is characterized by a food allergy-driven process, with a high rate of food allergy observed in patients. Esophageal inflammation is often reversible with dietary elimination of known food allergens.
Other condition in eosinophilic esophagitis noted with higher frequency are allergic rhinitis, eczema and asthma compared with healthy individuals. Seasonal exacerbations have been seen in children suggesting that food may not be the only trigger involved.
A recent study sought to define the rate of other conditions in eosinophilic esophagitis in pediatrics compared to patients who don’t have the condition.
Here are the results below: (first number is EoE patients vs. non EoE patients)
Allergic Rhinitis- 60% vs 17.4%
Asthma-59.8% vs 21.4%
Eczema-17.8% vs 6.6%
Adrenal insufficiency-2.6% vs 0.4%
Autism spectrum-7.5% vs 1.9%
Celiac disease-5.6% vs 0.9%
Connective Tissue Disease-1.4% vs 0.1%
Cystic Fibrosis-0.9% vs 0.05%
Inflammatory Bowel Disease-0.7% vs 0.2%
Type 1 Diabetes Mellitus-1.2% vs 0.3%
Based on this, children with eosinophilic esophagitis have markedly higher rates of both allergic and non allergic diseases compared to children without. The allergic diseases (allergic rhinitis, eczema and asthma) were significantly higher, indicating that eosinophilic esophagitis is an integral member of the allergy spectrum and it should be screened for in high risk individuals. There also should be more clinical awareness of patients in this group because they have more severe and difficult to manage asthma.
Furthermore, in patients with diagnoses of autism spectrum disorder, connective tissue diseases or other GI related diseases, those who have feeding difficulties or failure to thrive, should prompt EoE screening and referral to a qualified allergist and GI specialist.
Continued investigation into the underlying mechanism and the other conditions in eosinophilic esophagitis may enlighten our understanding, options for treatment and prevention in the future.