Epidemiology and risk factors for eosinophilic esophagitis: lessons for clinicians

ABSTRACT

Introduction

The rapid expansion in the epidemiology of eosinophilic esophagitis (EoE) is being documented, along with cumulative research assessing environmental exposures associated with EoE and susceptibility due to genetic variants.

Areas covered

Incidence rates for EoE of 5–10 new cases per 100,000 inhabitants annually have shown an increase in recent reports of up to 20 in some countries; the highest prevalence being reported for Europe and North America, where EoE now affects more than 1 out of 1,000 people. EoE has been shown to be associated with several disorders, Th2-mediated atopies being the most common. Patients with EoE exhibit increased frequency of asthma, allergic rhinitis and eczema, and EoE has been considered as a late component of the atopic march. Risk variants in TSLP, CAPN14 and LRCC32 genes, among others, have all been related to EoE, and interact with prenatal and early life exposure potentially modifying abundance and composition of gut microbiome. Dysregulated interactions between bacteria and mucosal immunity emerge as leading causes of EoE.

Expert opinion

The expanding epidemiology of EoE, the resources needed and subsequent increasing healthcare costs require additional effort to optimize cost-effective management and unveil mechanisms that enhance the development of future preventive strategies.

KEYWORDS:

• Eosinophilic esophagitis
• epidemiology
• prevalence
• incidence
• risk factors
• environment

Article highlights

• The prevalence figures for EoE have varied widely in recent years, depending on the definition used for the disease. However, the increasing trend in the number of patients diagnosed as suffering from this disease is unquestionable, with more than 1 out of 1,000 inhabitants being currently affected.

• The incidence rate for EoE in both children and adults is between 5 to 10 new cases per 100,000 inhabitants annually. Some recent studies, however, raise this rate to 20 new cases per 100,000 inhabitants annually. The increase in newly diagnosed cases of EoE exceeds the annual growth in the number of endoscopies performed.

• The increasing epidemiology of EoE has been interpreted in the context of expansion of immune-mediated disorders. In addition, increasing awareness among health professionals, generalization in the use of endoscopy and the recognition of PPI-responsive esophageal eosinophilia as EoE that responds to PPI, have contributed to elevating the epidemiology of this disease.

• Identifying risk factors for EoE is key to understanding the reasons underlying the increasing epidemiology of EoE. Several genetic susceptibility variants in components of the immune system, epithelial barriers and prenatal and early childhood exposures have been related to the risk of developing EoE. Most also predispose to concomitant Th-2 mediated allergies in the same patients, so disease-specific risk factors need to be further investigated.

• The continuous increase in the incidence and prevalence of EoE and its spread to all continents, the high costs of its management and complication of untreated cases will escalate costs for health systems in the near future. Identifying the interplay between risk factors and implementing preventive action constitute the major challenge over the coming years.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.