Cross-Sectional Comparative Study of Frequency of Eosinophilic Esophagitis in Patients with Upper Gastrointestinal Tract Symptoms

Abstract

Background: Eosinophilic esophagitis (EoE) is an increasingly recognized chronic immune-mediated inflammatory condition of the esophagus, now considered the second most common cause of chronic esophagitis after gastroesophageal reflux disease (GERD). This cross-sectional pilot study aimed to determine the frequency of EoE among patients presenting with upper gastrointestinal (GIT) symptoms.

Methods: this cross-sectional study included 100 adult patients (50 males and 50 females), aged 18 years and above, all participants were subjected to detailed medical history and underwent upper GI endoscopy for upper GIT symptoms. Exclusion criteria encompassed patients using medications that could induce esophagitis, those with collagen vascular diseases, scleroderma, or achalasia. During endoscopy, six biopsy samples were collected from the proximal, mid, and distal esophagus, even if the mucosa appeared normal, along with additional biopsies from the stomach and duodenum to rule out other conditions. Histopathological examination confirmed EoE based on the presence of ≥15 eosinophils per high-power field (HPF). this study was conducted at 6 October University Hospital and Cairo University Hospital.

Results: Among the 100 patients evaluated, 5% were diagnosed with EoE based on histopathological findings. Subjects having EoE were significantly older than who weren’t (P value <0.001). The prevalence was higher in males (8%) compared to females (2%) (P value 0.362) and more common in smokers (P value 0.156). Heartburn was the most commonly reported symptom, affecting 96% of patients (P value <0.001), followed by dysphagia 50% (P value 0.056) and vomiting 45% (P value 0.655). Food impaction occurred in 25% of cases (P value NA), with all instances associated with EoE. Endoscopic findings indicative of EoE, such as esophageal erosions, rings and linear furrows, were observed in 49%, 8% and 7% of cases, respectively (P value 0.025, 0.003 and 0.002). Notably, no statistically significant association was found between EoE and allergic rhinitis (24%), bronchial asthma (23%), or food allergy (14%), with p-values of 0.830, 0.605, and 0.587, respectively.

Conclusion: These findings suggest that EoE may be underdiagnosed among Egyptian patients with upper GIT symptoms, particularly given the potential overlap with GERD and other conditions. Increased awareness and systematic screening could improve diagnostic rates and inform tailored therapeutic strategies. Further large-scale multicenter studies are needed to validate these results and explore the epidemiological and clinical characteristics of EoE in diverse populations.