Women's Health Considerations in Eosinophilic Esophagitis

While eosinophilic esophagitis (EoE) is traditionally recognized as a male-predominant disease, its distinct presentation, underlying biology, and management in female patients warrant closer examination. Differing gene profiles between sexes and sex-specific genetic loci associated with disease development have been identified. Estrogen has been shown to have a protective role in EoE development; this may factor into the observed male-predominance. Women tend to have less dysphagia and are more likely to experience the inflammatory symptoms of abdominal pain, nausea, reflux, heartburn, chest pain, and epigastric pain. Females are also less likely to have strictures than males. Data on endoscopic and histologic findings between females and males is variable, with data suggesting that females tend to have less severe disease activity but similar or higher levels of symptoms and quality of life impairment. When it comes to pregnancy, symptoms can improve during pregnancy but may recur after delivery. Data suggests that PPIs, swallowed budesonide, and dupilumab may be safely continued during pregnancy. Elimination diets should be approached cautiously due to the potential for adverse outcomes associated with food restriction but could be considered under the supervision of a knowledgeable dietician. Further research is needed to better understand and treat EoE in women.