P0416 - Higher Prevalence of Allergic Comorbidities in Children With Eosinophilic Esophagitis Compared to Adults in the United States: A Population-Based Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

TQ

Thabet Qapaja, MD

Cleveland Clinic
Cleveland, OH

Thabet Qapaja, MD¹, Khaled Alsabbagh Alchirazi, MD¹, David Long, DO¹, Ahmed Nadeem, MD¹, Prashanthi N. Thota, MD²
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized by symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. EoE is increasing in prevalence with varied clinical manifestations among the adult and pediatric populations. We aimed to study the demographics, presenting symptoms, and allergic comorbidities of patients diagnosed with EoE between the years 2017-2022.

Methods: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of electronic health record data from 26 major integrated US healthcare systems from 2017 to 2022. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients with a diagnosis of EoE. We then calculated the prevalence of EoE and its associated symptoms and conditions among adult and pediatric populations. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value < 0.05 was considered statistically significant.

Results: Among the 28,362,860 individuals in the database between the years 2017 to 2022, we identified 27,640 patients with EoE with a 5-year prevalence of 97.5/100,000 persons. This is significantly higher than what was described in a previous study using the same database between the years 2010-2015, which reported a prevalence of 25.9/100,000. Prevalence was higher in adults (18-64 years) versus elderly ( >65 years) [OR 19.78; 95 % CI 18.91–20.69, p < 0.0001] and adults (18-64 years) versus children (age < 18) [OR 13.83; 95 % CI 13.27–14.42, p < 0.0001]. Prevalence was also higher in males versus females [OR 2.36; 95 % CI 2.28-2.44, p < 0.0001] and Caucasians versus African Americans [OR 48.86; 95 % CI 45.87–52.05, p < 0.0001]. Common symptoms are described in Table 1. Children with EoE were at higher risk of several allergic comorbidities including asthma, atopic dermatitis, eczema, urticaria, and IgE mediated food allergy when compared to adults with EoE (Table 1).

Discussion: Allergic comorbidities are frequent in patients with EoE and more so in pediatric population. Increased awareness and screening for comorbidities can enhance the management of this complex disease.

Symptoms of Eosinophilic Esophagitis in Pediatrics versus Adults
Associated symptoms	Age < 18 years N=4,390	Age ≥18 years N=23,230	OR	95% CI	p-value
Dysphagia	1,610 (37%)	12,540 (54%)	0.51	0.47-0.54	< 0.0001
Gastroesophageal reflux	1,740 (40%)	12,510 (54%)	0.56	0.52-0.61	< 0.0001
Abdominal pain	1,990 (45%)	10,460 (45%)	1.01	0.94-1.08	0.712
Chest pain	400 (9%)	6,810 (30%)	0.24	0.21-0.27	< 0.0001
Throat pain	210 (5%)	890 (4%)	1.26	1.08-1.47	0.0031
Nausea and vomiting	730 (17%)	3,510 (15%)	1.12	1.02-1.22	0.0105
Failure to thrive	880 (20%)	280 (1%)	20.55	17.88-23.61	< 0.0001
Diarrhea	50 (1%)	330 (1%)	0.79	0.59-1.07	0.1426
GI bleed	290 (7%)	3,450 (15%)	0.41	0.35-0.46	< 0.0001
Food impaction	150 (3%)	2,280 (10%)	0.32	0.27-0.38	< 0.0001
Esophageal perforation	NA	110 (0.5%)	NA	NA	NA
Allergic Comorbidities in Pediatrics versus Adults with Eosinophilic Esophagitis
Allergic comorbidity	Age < 18 years N=4,390	Age ≥18 years N=23,230	OR	95% CI	p-value
Drug allergy	690 (16%)	9,070 (39%)	0.29	0.26-0.31	< 0.0001
Asthma	1,690 (39%)	6,730 (29%)	1.53	1.43-1.64	< 0.0001
Sinusitis	950 (22%)	6,600 (28%)	0.69	0.64-0.75	< 0.0001
Atopic dermatitis	820 (19%)	850 (4%)	6.04	5.45-6.69	< 0.0001
IgE-mediated food allergy	1,940 (44%)	5,060 (22%)	2.84	2.65-3.04	< 0.0001
Eczema	1,310 (30%)	3,840 (17%)	2.14	1.99-2.31	< 0.0001
Urticaria	400 (9%)	1,240 (5%)	1.77	1.58-1.99	< 0.0001

Table: Table: Symptoms and Allergic Comorbidities of Eosinophilic Esophagitis in Pediatrics versus Adults

Disclosures:

Thabet Qapaja indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

David Long indicated no relevant financial relationships.

Ahmed Nadeem indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Thabet Qapaja, MD¹, Khaled Alsabbagh Alchirazi, MD¹, David Long, DO¹, Ahmed Nadeem, MD¹, Prashanthi N. Thota, MD². P0416 - Higher Prevalence of Allergic Comorbidities in Children With Eosinophilic Esophagitis Compared to Adults in the United States: A Population-Based Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.