- •
Eosinophilic esophagitis (EoE) affects patients of all ages, is more commonly seen in males, and whites, and is strongly associated with atopy.
- •
EoE is chronic, relapses are frequent after treatment is stopped, and diagnostic delay with persistent inflammation increases the risk of esophageal strictures and fibrostenotic complications.
- •
The prevalence of EoE is 0.5 to 1 cases/1000 persons.
- •
The incidence of EoE is approximately 10 cases/10,000 persons per year.
- •
Elucidating the reasons for the rapid
Epidemiology of Eosinophilic Esophagitis
Section snippets
Key points
Demographic features
EoE has been reported throughout the life span, from infancy to almost 100 years of age.10, 13, 23 However, most cases are in children, adolescents, and adults younger than 50 years.10, 13, 22, 23, 24 There is a consistent gender discrepancy, with males affected 3 to 4 times more commonly than females, and EoE is also more frequently reported in whites compared with other races/ethnicities.11, 13, 19, 22, 24, 25, 26, 27 The reason for the male predominance is not known, and as more data accrue
Natural history
EoE is considered a chronic disease.12, 13, 14 Data from the placebo arms of randomized clinical trials32, 33, 34, 35, 36, 37, 38 and prospective and retrospective cohort studies5, 6, 7, 10, 11, 39, 40, 41 show that EoE does not tend to spontaneously resolve or burn out. Specifically, the endoscopic signs and esophageal eosinophilia persist in the absence of treatment. Moreover, if treatment is stopped, symptoms, endoscopic signs, and esophageal eosinophilia recur in most patients over a period
Prevalence
The prevalence of a condition is defined by how many total cases exist during a given time frame in a specified location and is a useful measure of the burden of that disease. EoE has been described in many places throughout the world, including North America, Europe, South America, Australia, Asia, and the Middle East, but the prevalence seems to be highest in the United States, Western Europe, and Australia compared with Japan or China.17, 18, 19, 20, 21, 22, 54, 55, 56, 57, 58, 59, 60, 61, 62
Incidence
The incidence of a condition is how many new cases occur during a given time frame in a specified location, and is a measure of the number of people newly affected by a disease. The incidence of a condition can be low (a few new cases), but the prevalence can be relatively high if the condition is chronic and does not affect longevity. In addition, the incidence of a condition can be approximately equivalent to the prevalence for a condition that is either short-lived or highly morbid.
To study
Summary
The epidemiology of EoE has become increasingly well understood over the past decade. The disease is well characterized clinically, and those features have informed diagnostic guidelines. EoE can affect patients of any age, but there is a male predominance, it is more common in whites, and there is a strong association with atopic diseases. EoE is chronic, relapses are frequent with cessation of treatment, and new data suggest that unopposed inflammation and persistent symptoms with diagnostic
References (127)
- et al.
Eosinophilic esophagitis in a patient with vigorous achalasia
Gastroenterology
(1978) - et al.
Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula
Gastroenterology
(1995) - et al.
Eosinophilic esophagitis: a 10-year experience in 381 children
Clin Gastroenterol Hepatol
(2005) - et al.
Pediatric patients with eosinophilic esophagitis: an 8-year follow-up
J Allergy Clin Immunol
(2007) - et al.
Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years
Gastroenterology
(2003) - et al.
Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis
Gastrointest Endosc
(2006) - et al.
Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease
Clin Gastroenterol Hepatol
(2009) - et al.
Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment
Gastroenterology
(2007) - et al.
Eosinophilic esophagitis: updated consensus recommendations for children and adults
J Allergy Clin Immunol
(2011) - et al.
Eosinophilic esophagitis: escalating epidemiology?
J Allergy Clin Immunol
(2005)
The incidence and prevalence of eosinophilic esophagitis
J Allergy Clin Immunol
Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota
Clin Gastroenterol Hepatol
Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland
J Allergy Clin Immunol
Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups
Gastroenterology
A case-control study of sociodemographic and geographic characteristics of 335 children with eosinophilic esophagitis
Clin Gastroenterol Hepatol
Racial disparities in the presentation of pediatric eosinophilic esophagitis
J Allergy Clin Immunol
A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis
Gastroenterology
Swallowed fluticasone improves histologic but not symptomatic responses of adults with eosinophilic esophagitis
Clin Gastroenterol Hepatol
An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis
Gastroenterology
Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis
Clin Gastroenterol Hepatol
Long-term outcomes in pediatric-onset esophageal eosinophilia
J Allergy Clin Immunol
Long-term budesonide maintenance treatment is partially effective for patients with eosinophilic esophagitis
Clin Gastroenterol Hepatol
Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents
Am J Gastroenterol
Therapeutic end points in eosinophilic esophagitis: is elimination of esophageal eosinophils enough?
Clin Gastroenterol Hepatol
The natural history and complications of eosinophilic esophagitis
Thorac Surg Clin
The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis
Clin Gastroenterol Hepatol
Esophageal remodeling in pediatric eosinophilic esophagitis
J Allergy Clin Immunol
Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner
Gastroenterology
The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States
Clin Gastroenterol Hepatol
Association of eosinophilic inflammation with esophageal food impaction in adults
Gastrointest Endosc
Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis
Gastrointest Endosc
Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment
Gastrointest Endosc
Prevalence of eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease symptoms: a prospective study
Dig Liver Dis
Putting the puzzle together: epidemiological and clinical clues in the etiology of eosinophilic esophagitis
Immunol Allergy Clin North Am
Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982-1999
J Allergy Clin Immunol
Pollen and eosinophilic esophagitis
J Allergy Clin Immunol
Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome
Dig Dis Sci
Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings
Schweiz Med Wochenschr
Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder
J Clin Gastroenterol
14 years of eosinophilic esophagitis: clinical features and prognosis
J Pediatr Gastroenterol Nutr
ACG Clinical Guideline: evidence based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis
Am J Gastroenterol
Eosinophilic esophagitis
N Engl J Med
Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study
Gut
Rapidly increasing incidence of eosinophilic esophagitis in a large cohort
Neurogastroenterol Motil
Prevalence of eosinophilic esophagitis in the United States
Clin Gastroenterol Hepatol
Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review
Am J Gastroenterol
Clinical trial: eosinophilic esophagitis in patients presenting with dysphagia: a prospective analysis
Aliment Pharmacol Ther
Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study
Clin Gastroenterol Hepatol
Influence of race and gender on the presentation of eosinophilic esophagitis
Am J Gastroenterol
Mucosal eosinophilia: prevalence and racial/ethnic differences in symptoms and endoscopic findings in adults over 10 years in an urban hospital
J Clin Gastroenterol
Cited by (228)
The Index of Severity for Eosinophilic Esophagitis (I-SEE) Reflects Longitudinal Clinicopathologic Changes in Children
2024, Clinical Gastroenterology and HepatologyMachine learning–based identification and characterization of mast cells in eosinophilic esophagitis
2024, Journal of Allergy and Clinical ImmunologyEosinophilic esophagitis
2024, Medicine (Spain)Food Allergy Characteristics Associated With Coexisting Eosinophilic Esophagitis in FARE Registry Participants
2023, Journal of Allergy and Clinical Immunology: In PracticeAdverse events associated with EGD and EGD-related techniques
2022, Gastrointestinal EndoscopyNovel Questionnaires for Assessing Signs and Symptoms of Eosinophilic Esophagitis in Children
2022, Journal of Allergy and Clinical Immunology: In Practice
This work was supported in part by NIH award number K23 DK090073.
Disclosures: No conflicts of interest pertaining to this article. Dr E.S. Dellon has received research support from AstraZeneca, Meritage Pharma, Olympus, National Institutes of Health, ACG, AGA, and CURED Foundation. Dr E.S. Dellon has been a consultant for Aptalis, Novartis, Receptos, and Regeneron.