Epidemiology and Natural History of Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) has emerged over the past 2 decades as a major cause of upper gastrointestinal morbidity. Over this time, the epidemiology of EoE has also rapidly evolved. EoE has transformed from a rare case-reportable condition to disease that is commonly encountered in the gastroenterology clinic, hospital emergency room, and endoscopy suite. The incidence and prevalence are increasing at rates that outpace increased disease recognition. Current incidence estimates range from 5 to 10 cases per 100,000, and current prevalence estimates range from 0.5 to 1 case per 1000. We review the data and potential reasons behind this increase, examine risk factors, and identify important areas for research into disease etiology. The article also discusses the progression of EoE from an inflammatory to fibrostenotic phenotype. An accurate view of the natural history of EoE is central to discussions with patients regarding disease prognosis and decisions about long-term use of medical, endoscopic, and diet therapies. Progressive remodelling appears to be gradual, but not universal, and the duration of untreated disease is the best predictor of stricture risk. Ultimately, prospective, long-term outcome studies focusing on multiple aspects of disease activity are needed to fully understand the natural history of EoE.

Keywords: Fibrosis; Incidence; Prevalence; Progression.

Conflict of interest statement

Potential competing interests: None of the authors report any potential conflicts of interest with this study. Dr. Dellon is a consultant for Adare, Alvio, Banner, Enumeral, GSK, Receptos, Regeneron, and Shire; receives research funding from Meritage, Miraca, Nutricia, Receptos, Regeneron, and Shire; and has received an educational grant from Banner. Dr. Hirano is a consultant for Adare, Receptos, Regeneron, and Shire and has received research funding from Receptos, Regeneron, and Shire.

Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

(A) Time trends in EoE incidence from estimates in population-based studies. (B) Time trends in EoE prevalence from estimates in population-based studies.

Figure 2

Worldwide prevalence of EoE from estimates in population-based studies.

Figure 3

Prevalence of EoE in special populations including patients undergoing endoscopy for any reason, for dysphagia, for food bolus impaction, or for symptoms of refractory reflux.

Figure 4

Progression of EoE from inflammation to fibrosis.