Prevalence of elderly eosinophilic esophagitis and their clinical characteristics

Abstract

Background and Aims

Eosinophilic esophagitis (EoE) is predominantly found in middle-aged men among adults. There are few reports about EoE in the elderly, despite an ageing population. The study aimed to define the prevalence and clinical characteristics of EoE amongst older adults.

Methods

Elderly patients (defined as those ≥65 years) were compared to younger adults (18–64) in terms of clinical characteristics (age, gender, presenting symptoms, comorbidities), histological activity (eosinophil count), treatment modality and response to treatment. A pre- existing prospectively generated database of all EoE patients presenting to our department between February 2010 and December 2022 was interrogated. 309 patients who underwent endoscopy and esophageal biopsy and were found to have ≥15 eosinophils/HPF were defined as having EoE and were included for study. Statistical analyses were performed using Fisher’s extract test or Mann–Whitney U test.

Results

309 cases of EoE were recorded, mean age 45.7, range (21–88 years), of which20 patients were aged 65 years and over. Compared to younger patients, those aged ≥65 had more medical comorbidities (15 [75%] vs 111[38%], p = 0.002), and instead a non-significant trend toward less fibrosis (0.25 vs 0.46, p = 0.117). Although rate of cases required topical steroid (TCS) therapy was similar, none received repeated or maintenance TCS therapy in elderly.

Conclusion

In our cohort, only 20 patients (6%) were aged 65 years or older, suggesting that EoE is uncommon in the elderly. The clinical characteristics of EoE in the older age group were similar to the younger patients. Future studies with prospective data collection may determine if EoE disappears with age, or if the younger mean age is reflective of an increasing prevalence in recent years, that may be realized in the elderly EoE population in the future.

Keywords:

• Eosinophilic esophagitis
• elderly
• allergic diseases
• treatment efficacy
• comorbiditiy

Ethical approval

The study protocol was approved by the Ethics Committee of Osaka Metropolitan University Graduate School of Medicine (protocol numbers: 2020-151) and was performed in accordance with the principles of the Declaration of Helsinki. We disclosed the study information on our website, and the patients had the opportunity to opt out.

Author contributions

Study conception and design: YF; Acquisition of data: All: Statistical analysis: YF. Interpretation of data: All; Drafting of the manuscript: YF; Critical revision: All; Guarantor of the article: YF; All authors approved the final version of the article, including the authorship list.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by JSPS KAKENHI Grant Number [JP21K07948] YF has received lecture fees from Takeda, AstraZeneca, EA Pharma, Daiichi-Sankyo, and Otsuka.