Clin Endosc.  2018 Jul;51(4):357-361. 10.5946/ce.2017.166.

Prevalence of Eosinophilic Esophagitis in Adult Patients with Upper Gastrointestinal Symptoms in a Locality in Upper Egypt

• Fouad M
• Fouad YM
• Mokareb HA
• Mohamed EA
• Abdel-Rehim DM

• KMID: 2419707
• DOI: http://doi.org/10.5946/ce.2017.166

Abstract

BACKGROUND/AIMS
Eosinophilic esophagitis (EoE) is gaining importance in the diagnosis of upper gastrointestinal (UGI) symptoms. Diagnosis is based on the clinical presentation of esophageal dysfunction and pathological findings in the absence of other causes of tissue eosinophilia. Our study was designed to evaluate EoE prevalence in patients with UGI symptoms in our locality (El-Minia, Egypt).
METHODS
This single-center, cross-sectional study recruited all patients with UGI symptoms who agreed for endoscopic evaluation. Esophageal biopsy samples were obtained and histological evaluation for the presence of eosinophils was performed for every patient. EoE was defined when at least 15 eosinophils were present in a single high-power field, in the absence of other causes of esophageal eosinophilia.
RESULTS
Between 2013 and 2015, 218 of 476 adult patients with UGI symptoms underwent upper endoscopy after giving consent. Among the 218 patients, only 4 (1.87%) had the diagnosis of EoE based on the presence of eosinophils in esophageal biopsies and exclusion of other causes of esophageal eosinophilia. Three patients with EoE presented mainly with dysphagia (75%) and/or other UGI symptoms, such as heartburn.
CONCLUSIONS
We observed a low prevalence of EoE in our locality. The diagnosis of EoE should be considered in patients with dysphagia and/or heartburn.

Keyword

Eosinophilic esophagitis; Endoscopy; Upper gastrointestinal symptoms; Egypt, El-Minia

MeSH Terms

Adult*
Biopsy
Cross-Sectional Studies
Deglutition Disorders
Diagnosis
Egypt*
Endoscopy
Eosinophilia
Eosinophilic Esophagitis*
Eosinophils*
Heartburn
Humans
Prevalence*

Reference

1. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013; 108:679–692. quiz 693.

2. Dellon ES. Diagnosis and management of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2012; 10:1066–1078.

3. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011; 128:3–20. e6; quiz 21-22.

4. Prasad GA, Alexander JA, Schleck CD, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009; 7:1055–1061.

5. Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol. 2005; 115:418–419.

6. Whitney-Miller CL, Katzka D, Furth EE. Eosinophilic esophagitis: a retrospective review of esophageal biopsy specimens from 1992 to 2004 at an adult academic medical center. Am J Clin Pathol. 2009; 131:788–792.

7. Kerlin P, Jones D, Remedios M, Campbell C. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol. 2007; 41:356–361.

8. Prasad GA, Talley NJ, Romero Y, et al. Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study. Am J Gastroenterol. 2007; 102:2627–2632.

9. Ramakrishnan R, Chong H. Eosinophilic oesophagitis in adults. Histopathology. 2008; 52:897–900.

10. Mackenzie SH, Go M, Chadwick B, et al. Eosinophilic oesophagitis in patients presenting with dysphagia--a prospective analysis. Aliment Pharmacol Ther. 2008; 28:1140–1146.

11. Foroutan M, Norouzi A, Molaei M, et al. Eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease. Dig Dis Sci. 2010; 55:28–31.

12. Almansa C, Devault KR, Achem SR. A comprehensive review of eosinophilic esophagitis in adults. J Clin Gastroenterol. 2011; 45:658–664.

13. Veerappan GR, Perry JL, Duncan TJ, et al. Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study. Clin Gastroenterol Hepatol. 2009; 7:420–426. 426.e1-e2.

14. Spechler SJ, Genta RM, Souza RF. Thoughts on the complex relationship between gastroesophageal reflux disease and eosinophilic esophagitis. Am J Gastroenterol. 2007; 102:1301–1306.

15. Antonioli DA, Furuta GT. Allergic eosinophilic esophagitis: a primer for pathologists. Semin Diagn Pathol. 2005; 22:266–272.

16. Sgouros SN, Bergele C, Mantides A. Eosinophilic esophagitis in adults: a systematic review. Eur J Gastroenterol Hepatol. 2006; 18:211–217.

17. Ronkainen J, Talley NJ, Aro P, et al. Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study. Gut. 2007; 56:615–620.

18. Hunter SS, Helmy DO, Zayed NA, El-Tayeb TM, El-Serafy MA. Eosinophilic esophagitis in Egyptian adult patients presenting with upper gastrointestinal symptoms. Open Journal of Gastroenterology. 2014; 4:88–95.

19. Gupta SK, Fitzgerald JF, Chong SK, Croffie JM, Collins MH. Vertical lines in distal esophageal mucosa (VLEM): a true endoscopic manifestation of esophagitis in children? Gastrointest Endosc. 1997; 45:485–489.

20. Moy N, Heckman MG, Gonsalves N, Achem SR, Hirano I. Inter-observer agreement on endoscopic esophageal findings in eosinophilic esophagitis (EoE). Gastroenterology. 2011; 140(5 Suppl 1):S236.

21. Peery AF, Cao H, Dominik R, Shaheen NJ, Dellon ES. Variable reliability of endoscopic findings with white-light and narrow-band imaging for patients with suspected eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2011; 9:475–480.

22. Fox VL, Nurko S, Furuta GT. Eosinophilic esophagitis: it’s not just kid’s stuff. Gastrointest Endosc. 2002; 56:260–270.

23. Parfitt JR, Gregor JC, Suskin NG, Jawa HA, Driman DK. Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients. Mod Pathol. 2006; 19:90–96.

24. Dellon ES, Gibbs WB, Fritchie KJ, et al. Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2009; 7:1305–1313. quiz 1261.

25. Croese J, Fairley SK, Masson JW, et al. Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc. 2003; 58:516–522.

26. Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci. 1993; 38:109–116.

27. Kim HP, Vance RB, Shaheen NJ, Dellon ES. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol. 2012; 10:988–996. e5.

28. Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007; 133:1342–1363.

29. Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA. Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology. 2008; 134:1316–1321.