Emerging eosinophilic (allergic) esophagitis: increased incidence or increased recognition?

Area of Science:

• Gastroenterology
• Pathology
• Epidemiology

Background:

• Eosinophilic esophagitis (EoE) is characterized by intraepithelial eosinophils and endoscopic findings like trachealization.
• Historically, intraepithelial eosinophils were linked to reflux esophagitis, with less focus on their density or location.
• Recent reports suggest a rising incidence of EoE, prompting investigation into potential environmental factors.

Purpose of the Study:

• To investigate the reported increase in the prevalence of eosinophilic esophagitis.
• To compare the incidence of EoE in two distinct time periods.

Main Methods:

• A comparative analysis of esophageal biopsies from 1990 (n=115) and 2005 (n=150) was conducted.
• Consecutive patients undergoing esophageal biopsies were included, excluding those with Barrett metaplasia or carcinoma.
• EoE was defined as >20 intraepithelial eosinophils per high-power field, with the highest density recorded per patient.

Main Results:

• No statistically significant difference in the incidence of eosinophilic esophagitis was observed between 1990 and 2005.
• The study found no evidence to support an increase in disease incidence linked to environmental changes.

Conclusions:

• The perceived increase in eosinophilic esophagitis incidence is primarily attributed to enhanced diagnostic recognition.
• The findings suggest that improved awareness and diagnostic criteria, rather than environmental factors, explain the apparent rise in EoE cases.