Digestive Diseases and Sciences

, Volume 60, Issue 6, pp 1716–1723 | Cite as

Prevalence of Esophageal Eosinophilia and Eosinophilic Esophagitis in Adults: A Population-Based Endoscopic Study in Shanghai, China

  • Xiuqiang Ma
  • Qin Xu
  • Yanling Zheng
  • Yanfang Zhao
  • Jian Lu
  • Rui Wang
  • Zhaoshen Li
  • Duowu Zou
  • Jia He
Original Article


Background and Aim

Population-based endoscopic studies of esophageal eosinophilia and eosinophilic esophagitis are limited in the world. This study was aiming to describe features of esophageal eosinophilia and eosinophilic esophagitis in a representative sample of the adult in Shanghai, China.


As part of a large epidemiological study, 3,600 individuals (aged 18–80 years) were randomly selected in Shanghai, China. They were asked to undergo endoscopy and have at least four esophageal biopsies taken from 0.5 cm above the Z-line and any abnormal areas. Any eosinophil infiltration of the epithelium was defined as esophageal eosinophilia. Eosinophilic esophagitis was defined as ≥15 eosinophils/high-power field in esophageal biopsies.


A total of 1,030 individuals accepted to have endoscopy and 1,021 individuals with biopsy results were suitable for analysis. Esophageal eosinophilia was present in 67 subjects (6.6 %). Eosinophilic esophagitis was present in four cases (0.4 %). No significant association was found between the presence of esophageal eosinophilia and reflux esophagitis, Barrett’s esophagus, symptom-defined gastroesophageal reflux disease or H. pylori infection. Most individuals with esophageal eosinophilia (80.6 %) did not have any of the upper gastrointestinal symptoms.


Esophageal eosinophilia was present in nearly 6.6 % of the general adult population of China; 0.4 % had eosinophilic esophagitis. Most of individuals with esophageal eosinophilia were asymptomatic.


Esophageal eosinophilia Eosinophilic esophagitis Endoscopy Epidemiology China 



The study, which is part of the SILC study, was funded by AstraZeneca R&D, Mölndal, Sweden, and the program of the Key Discipline Construction of Public Health of Shanghai. We thank the respondents who gave their time and effort to participate in this study.

Conflict of interest

Xiuqiang Ma, Qin Xu, Yanling Zheng, Yanfang Zhao, Jian Lu, Rui Wang, Zhaoshen Li, and Duowu Zou declare that they have no conflict of interest. Jia He has served as the director of the Department of Health Statistics, Second Military Medical University and has received research funding from AstraZeneca.


  1. 1.
    Rothenberg ME, Hogan SP. The eosinophil. Annu Rev Immunol. 2006;24:147–174.CrossRefPubMedGoogle Scholar
  2. 2.
    Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133:1342–1363.CrossRefPubMedGoogle Scholar
  3. 3.
    Furuta K, Adachi K, Kowari K, et al. A Japanese case of eosinophilic esophagitis. J Gastroenterol. 2006;41:706–710.CrossRefPubMedGoogle Scholar
  4. 4.
    Straumann A, Beglinger C. Eosinophilic esophagitis: the endoscopist’s enigma. Gastrointest Endosc. 2006;63:13–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74:1298–1301.PubMedGoogle Scholar
  6. 6.
    Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ. Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review. Am J Gastroenterol. 2007;102:2300–2313.CrossRefPubMedGoogle Scholar
  7. 7.
    Spergel JM, Book WM, Mays E, et al. Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States. JPGN. 2011;52:300–306.PubMedGoogle Scholar
  8. 8.
    Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA. Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology. 2008;134:1316–1321.CrossRefPubMedGoogle Scholar
  9. 9.
    Furuta GT, Straumann A. Review article: the pathogenesis and management of eosinophilic oesophagitis. Aliment Pharmacol Ther. 2006;24:173–182.CrossRefPubMedGoogle Scholar
  10. 10.
    Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351:940–941.CrossRefPubMedGoogle Scholar
  11. 11.
    Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol. 2005;115:418–419.CrossRefPubMedGoogle Scholar
  12. 12.
    Blanchard C, Wang N, Rothenberg ME. Eosinophilic esophagitis: pathogenesis, genetics, and therapy. J Allergy Clin Immunol. 2006;118:1054–1059.CrossRefPubMedGoogle Scholar
  13. 13.
    Noel RJ, Tipnis NA. Eosinophilic esophagitis—a mimic of GERD. Int J Pediatr Otorhinolaryngol. 2006;70:1147–1153.CrossRefPubMedGoogle Scholar
  14. 14.
    Ronkainen J, Talley NJ, Aro P, et al. Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study. Gut. 2007;56:615–620.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Cohen MS, Kaufman AB, Palazzo JP, Nevin D, Dimarino AJ Jr, Cohen S. An audit of endoscopic complications in adult eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2007;5:1149–1153.CrossRefPubMedGoogle Scholar
  16. 16.
    Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3 e26–20 e26; quiz 21–22.Google Scholar
  17. 17.
    Ferguson DD, Foxx-Orenstein AE. Eosinophilic esophagitis: an update. Dis Esophagus. 2007;20:2–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Lu HC, Lu CL, Chang FY. Eosinophilic esophagitis in an asymptomatic Chinese. J Chin Med Assoc. 2008;71:362–364.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee B, Park H, Yoon H, Kim HK, Kim HS. Three cases of eosinophilic esophagitis with dysphagia as a chief complaint Korean. J Gastrointest Endosc. 2008;36:145–149.Google Scholar
  20. 20.
    Attwood SE. Eosinophils and gut dysmotility. Eur J Gastroenterol Hepatol. 2005;17:891–892.CrossRefPubMedGoogle Scholar
  21. 21.
    Yan X, Wang R, Zhao Y, et al. Systematic investigation of gastrointestinal diseases in China (SILC): validation of survey methodology. BMC Gastroenterol. 2009;9:86.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Shaw MJ, Talley NJ, Beebe TJ, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:52–57.CrossRefPubMedGoogle Scholar
  23. 23.
    Cao Y, Yan X, Ma XQ, et al. Validation of a survey methodology for gastroesophageal reflux disease in China. BMC Gastroenterol. 2008;8:37.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Storskrubb T, Aro P, Ronkainen J, et al. Serum biomarkers provide an accurate method for diagnosis of atrophic gastritis in a general population: the Kalixanda study. Scand J Gastroenterol. 2008;43:1448–1455.CrossRefPubMedGoogle Scholar
  25. 25.
    Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus Am J Gastroenterol. 2006;101:1900–1920; quiz 1943.Google Scholar
  26. 26.
    Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–1399.CrossRefPubMedGoogle Scholar
  28. 28.
    Avidan B, Sonnenberg A, Schnell TG, Sontag SJ. Hiatal hernia and acid reflux frequency predict presence and length of Barrett’s esophagus. Dig Dis Sci. 2002;47:256–264.CrossRefPubMedGoogle Scholar
  29. 29.
    Drossman DA, Corazziari E, Talley N, Thompson WG, Whitehead WE. Rome II: a multinational consensus document on functional gastrointestinal disorders. Gut. 1999;45:1–81.CrossRefGoogle Scholar
  30. 30.
    WHO. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–163.CrossRefGoogle Scholar
  31. 31.
  32. 32.
    Chang F, Anderson S. Clinical and pathological features of eosinophilic oesophagitis: a review. Pathology. 2008;40:3–8.CrossRefPubMedGoogle Scholar
  33. 33.
    DeBrosse CW, Collins MH, Buckmeier Butz BK, et al. Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982–1999. J Allergy Clin Immunol. 2010;126:112–119.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Shi YN, Sun SJ, Xiong LS, Cao QH, Cui Y, Chen MH. Prevalence, clinical manifestations and endoscopic features of eosinophilic esophagitis: a pathological review in China. J Dig Dis. 2012;13:304–309.CrossRefPubMedGoogle Scholar
  35. 35.
    Remedios M, Campbell C, Jones DM, Kerlin P. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc. 2006;63:3–12.CrossRefPubMedGoogle Scholar
  36. 36.
    Sgouros SN, Bergele C, Mantides A. Eosinophilic esophagitis in adults: a systematic review. Eur J Gastroenterol Hepatol. 2006;18:211–217.CrossRefPubMedGoogle Scholar
  37. 37.
    Fox VL, Nurko S, Furuta GT. Eosinophilic esophagitis: it’s not just kid’s stuff. Gastrointest Endosc. 2002;56:260–270.CrossRefPubMedGoogle Scholar
  38. 38.
    Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci. 1993;38:109–116.CrossRefPubMedGoogle Scholar
  39. 39.
    Mukkada V, Atkins D, Furuta GT. Uncertain association of Barrett’s esophagus with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2008;6:832; author reply 832–833.Google Scholar
  40. 40.
    Francalanci P, De Angelis P, Minnei F, et al. Eosinophilic esophagitis and Barrett’s esophagus: an occasional association or an overlap disease? Digestion. 2008;77:16–19.CrossRefPubMedGoogle Scholar
  41. 41.
    Wolfsen HC, Hemminger LL, Achem SR. Eosinophilic esophagitis and Barrett’s esophagus with dysplasia. Clin Gastroenterol Hepatol. 2007;5:A18.CrossRefPubMedGoogle Scholar
  42. 42.
    Mukkada V, Atkins D, Furuta GT. Letter to the editors: uncertain association of Barrett’s esophagus with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2008;6:832–833.CrossRefPubMedGoogle Scholar
  43. 43.
    Dellon ES, Peery AF, Shaheen NJ, et al. Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database. Gastroenterology. 2011;141:1586–1592.CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Prasad GA, Talley NJ, Romero Y, et al. Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study. Am J Gastroenterol. 2007;102:2627–2632.CrossRefPubMedGoogle Scholar
  45. 45.
    Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108:679–692; quiz 693.Google Scholar
  46. 46.
    Dellon ES. Diagnostics of eosinophilic esophagitis: clinical, endoscopic, and histologic pitfalls. Dig Dis (Basel, Switzerland). 2014;32:48–53.CrossRefGoogle Scholar
  47. 47.
    Wang D, He Y, Li Y, et al. Dietary patterns and hypertension among Chinese adults: a nationally representative cross-sectional study. BMC Public Health. 2011;11:925.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Xiuqiang Ma
    • 1
  • Qin Xu
    • 1
  • Yanling Zheng
    • 2
  • Yanfang Zhao
    • 1
  • Jian Lu
    • 1
  • Rui Wang
    • 1
  • Zhaoshen Li
    • 3
  • Duowu Zou
    • 3
  • Jia He
    • 1
  1. 1.Department of Health StatisticsSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Teaching Affairs and Scientific ResearchShandong Medical CollegeJinan CityChina
  3. 3.Department of Gastroenterology, Changhai HospitalSecond Military Medical UniversityShanghaiChina

Personalised recommendations