University of North Carolina School of Medicine Chapel Hill, North Carolina
Introduction: Patients with eosinophilic esophagitis (EoE) commonly have other atopic conditions, but the impace of multipe allergic diseases is unknown. We aimed to determine whether EoE patients with multiple atopic conditions have differences in presentation or response to topical corticosteroid (tCS) treatment.
Methods: This retrospective cohort study of the UNC EoE Clinicopathologic database assessed adults and children with a new diagnosis of EoE. Demographics, clinical characteristics, and procedural data were extracted. We calculated the total number of atopic comorbidities and defined a group with ≥2 atopic conditions (not including allergic rhinitis given its high prevalence in our region). For those with tCS treatment and follow-up endoscopy/biopsy, we assessed histologic response (< 15 eos/hpf), global symptom response, endoscopic response, EREFS, and an endoscopic severity score (ESS). Patients with and without multiple atopic conditions were compared at baseline, and also before and after treatment.
Results: Of 1020 EoE patients with atopic disease information, 426 (42%) had no atopy, 235 (23%) had 1 atopic comorbidity, 211 (21%) had 2, 113 (11%) had 3, and 34 (3%) had 4. The mean age of EoE diagnosis varied by associated atopic condition (EoE in patients with eczema was diagnosed at 18.5 yrs, with food allergy at 24.5 yrs, asthma at 27 yrs, allergic rhinitis at 28 yrs). The 180 (18%) patients with ≥2 atopic diseases were younger (22 vs 31 yrs; p< 0.001) and had more vomiting, less abdominal pain, more exudates and edema on endoscopy, and higher peak eosinophil counts (73.4 vs 62.6; p=0.003). On multivariate analysis, younger age, lack of abdominal pain, exudates, and higher eosinophil counts were independently associated with multiple atopy. In 465 patients treated with tCS, there was no difference in histologic response in patients with and without multiple atopic conditions (Table 1), and response rates were between 56%-63% for patients with 0-4 concomitant atopic conditions.
Discussion: EoE patients commonly have multiple atopic diseases. At time of diagnosis, patients with ≥2 atopic diseases were younger, less likely to have abdominal pain, and more likely to have exudates on endoscopy and a higher eosinophil count on biopsy. However, there were no major differences in histologic treatment response to corticosteroids, though a non-response rate of ~40% was seen regardless of atopic status.
