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Increasing Age at the Time of Diagnosis and Evolving Phenotypes of Eosinophilic Esophagitis Over 20 Years

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An Invited Commentary to this article was published on 15 November 2023

Abstract

Background

The presentation of eosinophilic esophagitis (EoE) is heterogeneous, but trends over time are not known.

Aim

To determine whether clinical and endoscopic phenotypes at EoE diagnosis have changed over the past 2 decades.

Methods

In this retrospective cohort study, adults and children with newly diagnosed EoE were phenotyped as follows: (1) inflammatory vs fibrostenotic vs mixed on endoscopy; (2) atopic vs non-atopic; (3) age at symptom onset; (4) age at diagnosis; (5) presence of autoimmune or connective tissue disease; and (6) responsive to steroids. The prevalence of different phenotypes was categorized by 5-year intervals. Multivariate analysis was performed to assess for changes in patient features over time.

Results

Of 1187 EoE patients, age at diagnosis increased over time (from 22.0 years in 2002–2006 to 31.8 years in 2017–2021; p < 0.001) as did the frequency of dysphagia (67% to 92%; p < 0.001). Endoscopic phenotypes were increasingly mixed (26% vs 68%; p < 0.001) and an increasing proportion of patients had later onset of EoE. However, there were no significant trends for concomitant autoimmune/connective tissue disease or steroid responder phenotypes. On multivariate analysis, after accounting for age, dysphagia, and food impaction, the increase in the mixed endoscopic phenotype persisted (aOR 1.51 per each 5-year interval, 95% CI 1.31–1.73).

Conclusion

EoE phenotypes have changed over the past two decades, with increasing age at diagnosis and age at symptom onset. The mixed endoscopic phenotype also increased, even after controlling for age and symptomatology. Whether this reflects changes in provider recognition or disease pathophysiology is yet to be elucidated.

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Funding

This study was supported by NIH T35 DK007386, T32 DK007634, and T32 HD094671.

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Authors and Affiliations

  1. Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Akshatha Kiran, Brenderia A. Cameron, Zeyun Xue, Sean LaFata, Adolfo A. Ocampo, Justin McCallen, Christopher J. Lee, Walker D. Redd, Cary C. Cotton, Swathi Eluri, Craig C. Reed & Evan S. Dellon

  2. Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Stephanie A. Borinsky

  3. Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, CB#7080 Bioinformatics Building, 130 Mason Farm Rd., UNC-CH, Chapel Hill, NC, 27599-7080, USA

    Evan S. Dellon

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  1. Akshatha Kiran
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Contributions

All authors approved the final manuscript: AK contributed to study design, data collection and interpretation, manuscript drafting, and critical revision. BAC, ZX, SL, AAO, JM, CJL, SAB, WDR, CCC, SE, and CCR contributed to data collection and interpretation and critical revision. ESD contributed to project conception, supervision, study design, data collection, data analysis/interpretation, manuscript drafting, and critical revision.

Corresponding author

Correspondence to Evan S. Dellon.

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None of the authors report any potential conflicts of interest with this study.

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An invited commentary on this article is available at https://doi.org/10.1007/s10620-023-08166-y.

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Kiran, A., Cameron, B.A., Xue, Z. et al. Increasing Age at the Time of Diagnosis and Evolving Phenotypes of Eosinophilic Esophagitis Over 20 Years. Dig Dis Sci 69, 521–527 (2024). https://doi.org/10.1007/s10620-023-08165-z

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