- Email: [email protected]
Mo1853 Low Prevalence of Eosinophilic Esophagitis in Hispanics and Asians in the United States
20% were on both a steroid and a PPI, and 21% were on diet therapy. 50% had histologic evidence of active disease on biopsy while almost 40% denied dysphagia at the time of assessment. Scores on the QOL survey ranged from 15-96, with a mean of 69.5 (± 19.7). Dysphagia frequency and severity were significantly correlated with overall QOL score as well as each QOL subscore (p<0.001). Patients who reported self-limited food impactions had worse emotional QOL (p=0.04), disease anxiety (p=0.03), and social QOL (p=0.04). In addition, patients on diet therapy reported worse eating/dietary QOL than those primarily on medications (p=0.05). There was no difference in QOL scores based on duration of symptoms or years since diagnosis. Patients with stricture at time of endoscopy reported significantly worse social QOL (p=0.02) and disease anxiety (p=0.04). The presence of edema, rings, and exudates on endoscopy had no relation to a patient's QOL score. Furthermore, the presence of eosinophilia (≥15 eos/hpf) on biopsy was not associated with worse overall QOL, although those with histologically active disease did report worse social QOL (p= 0.03). Conclusions: Dysphagia severity in EoE is associated with reduced overall QOL, emotional function and social and disease related anxiety. QOL in EoE is not consistently associated with endoscopic and histologic findings. The evaluation of EoE severity and therapeutic response should incorporate assessment of QOL.
Mo1854
Background: Eosinophilic gastroenteritis (EGE) is a rare condition. It belongs to the family of eosinophilic gastrointestinal diseases where eosinophilic inflammation occurs in the GI tract in the absence of secondary causes. Despite being described nearly three-fourths of a century ago, little is known regarding the etiology, pathogenesis, or natural history of EGE. Aim: To characterize the clinical, endoscopic, and histopathologic features of EGE and to summarize treatment outcomes. Methods: We conducted a retrospective cohort study at the University of North Carolina. To identify patients with EGE, pathology reports of all patients who had undergone upper endoscopy with biopsy between January 1, 2000 and June 20, 2013 were reviewed if the term "eosinophil" was mentioned anywhere in the report. Eosinophilic gastroenteritis was diagnosed if there were ≥ 20 eosinophils/hpf (hpf=0.24mm2) on either gastric or duodenal biopsy, symptoms attributable to the GI tract, and no known secondary cause of eosinophilia. Data were extracted from electronic medical records including: patient demographics, co-morbidities, medications, endoscopic findings, treatment, and outcomes (symptomatic, endoscopic, and histologic response). Descriptive statistics were used to characterize patients diagnosed with EGE and bivariate analysis was performed to compare adults (≥18 yrs) and children. Results: There were 44 patients diagnosed with EGE (mean age 16 yrs; 58% male; 58% white). The most common presenting symptoms were vomiting (71%) and abdominal pain (62%). Food allergies were noted in 42%, and 64% had a family history of atopic disease. There were few differences between children and adults (see Table 1). Of the EGE cases, 12 (30%) had both gastric and duodenal involvement, 18 (45%) had gastric involvement only, 10 (25%) had duodenal involvement only, 12 (30%) had overlapping eosinophilic esophagitis (EoE), and 11 (28%) had overlapping eosinophilic colitis (EC). Average eosinophil counts were 61, 55, 56, and 84 for the stomach, duodenum, esophagus, and colon respectively. For treatment, 36 (80%) received corticosteroids, 21 (47%) had dietary restriction, and 34 (76%) required >1 treatment modality. Overall, 27 (60%) had symptom resolution and 23 (51%) had endoscopic resolution, with higher response rates noted for oral steroids than for diet modification, leukotriene antagonists, H2 blockers, or mast-cell inhibitors. For diagnosis and treatment monitoring, EGE cases underwent a mean of 5 endoscopic procedures per year. Conclusion: EGE presents with non-specific GI symptoms, and in almost one-third of cases overlaps with either EoE or EC. It remains difficult to treat, with only just over half of patients responding to treatment. Management of EGE is resource intensive, with high rates of endoscopic utilization. Comparison of adults and children (<18 yrs) with eosinophilic gastroenteritis
Mo1853 Low Prevalence of Eosinophilic Esophagitis in Hispanics and Asians in the United States Robert M. Genta, Stuart J. Spechler Introduction: National differences in the prevalence of eosinophilic esophagitis (EoE) have been described, but it is not clear whether these differences are real (due to differences in genetic or environmental factors) or spurious (due to national differences in awareness of the condition among physicians and in their recognition of the endoscopic and histological features of EoE). Prevalence rates for EoE in reports from Asia have been highly variable (e.g., 0.01% in a study from Japan, 0.34% in a study from China, 6.6% in a study from Korea). To minimize confounding due to national differences in physician factors relating to the diagnosis of EoE, we estimated the prevalence of EoE in patients of different ethnicities who had endoscopy performed in the U.S. with esophageal biopsies evaluated by a group of gastrointestinal pathologists in the U.S. Methods: Using a large national pathology database, which includes demographic, clinical, endoscopic and histopathological data from patients who have endoscopic procedures with biopsies in outpatient endoscopy centers throughout the U.S., we categorized all patients who had esophageal biopsies according to their ethnic origin as follows: Hispanics, Japanese, other East Asians (Koreans, Chinese, and Vietnamese), Indians, and Other Americans (mostly Caucasians and African-Americans). We then evaluated the prevalence of EoE as diagnosed by: 1) histological evaluation of esophageal biopsy specimens showing ≥15 eosinophils per high power field, and 2) clinical data (symptoms and/or endoscopic findings) compatible with EoE. Comparisons were made using unadjusted odds ratios. Results: We identified a total of 77,788 unique patients who had esophageal biopsy specimens including 18,685 Hispanics (median age 54 years; 43% male), 4,071 East Asians (median age 56 years; 46% male), 272 Japanese (median age 59; 48% male), 1,840 Indians (median age 52 years, 55% male), and 52,920 Other Americans (median age 57 years; 47% male). The prevalence of EoE in each group is depicted in Figure 1. Note that the prevalence of EoE in Hispanics and East Asians is less than half that in Other Americans. Conclusions: There appear to be significant differences in the prevalence of EoE among different ethnic groups in the U.S., with especially low prevalence rates in Hispanics and East Asians.
Mo1855 When Eosinophilic Esophagitis Is Refractory to Topical Steroids: Treatment Options and Clinical Outcomes Cary C. Cotton, Daniel J. Green, Julia T. Hughes, W. Asher Wolf, John T. Woosley, Nicholas J. Shaheen, Evan S. Dellon Background: Topical steroids are the first-line pharmacologic agents for treatment of eosinophilic esophagitis (EoE). For patients who do not respond to these medications, treatment regimens are not standardized, and outcomes of second-line therapies are poorly described. Aim: To assess the treatment outcomes for patients unresponsive to topical steroid therapy for EoE. Methods: This was a retrospective cohort study of the University of North Carolina EoE Clinicopathologic database from 2001-2013. Subjects with an incident diagnosis of EoE who met consensus guidelines were included. All had symptoms of esophageal dysfunction, ≥15 eos/hpf (hpf area=0.24 mm2), and did not respond to a PPI trial. Patients who were treated with 2 months of a topical steroid (fluticasone 880-1760mcg/day or budesonide 1-2mg/day) were identified. Demographic and pre/post treatment symptom (patient-reported global improvement), endoscopic (endoscopist-reported improvement), and histologic data were extracted from medical records. To identify the most difficult to treat group, we defined refractory patients as having ≥30 eos/hpf with either persistent symptoms or persistent endoscopic findings after topical steroids. Treatments subsequent to the topical steroids were recorded, and outcomes were assessed. Successful rescue therapy was defined as <15 eos/hpf. Results: Of the 307 EoE patients treated with topical steroids, 155 had complete symptomatic, endoscopic, and histologic data, and 51 (mean age 24, 69% male, 76% white, mean baseline 80 eos/hpf, post-steroid 78 eos/hpf) met our refractory criteria. In 4 of these patients, lack of response was due to non-adherence, and follow-up data were available on
Percentage of unique patients with esophageal biopsies with a histopathologic diagnosis of EoE. Odds Ratios relative to the group "Other Americans" are depicted on top of each bar. Other Americans included Caucasian and African American patients; East Asians included subjects of Chinese, Korean, and Vietnamese origin. Indians included patients with ancestry in the Indian Subcontinent.
S-673
AGA Abstracts
AGA Abstracts
Clinical Characteristics, Treatment Outcomes, and Resource Utilization in Children and Adults With Eosinophilic Gastroenteritis Craig Reed, John T. Woosley, Evan S. Dellon
Mo1854
Background: Eosinophilic gastroenteritis (EGE) is a rare condition. It belongs to the family of eosinophilic gastrointestinal diseases where eosinophilic inflammation occurs in the GI tract in the absence of secondary causes. Despite being described nearly three-fourths of a century ago, little is known regarding the etiology, pathogenesis, or natural history of EGE. Aim: To characterize the clinical, endoscopic, and histopathologic features of EGE and to summarize treatment outcomes. Methods: We conducted a retrospective cohort study at the University of North Carolina. To identify patients with EGE, pathology reports of all patients who had undergone upper endoscopy with biopsy between January 1, 2000 and June 20, 2013 were reviewed if the term "eosinophil" was mentioned anywhere in the report. Eosinophilic gastroenteritis was diagnosed if there were ≥ 20 eosinophils/hpf (hpf=0.24mm2) on either gastric or duodenal biopsy, symptoms attributable to the GI tract, and no known secondary cause of eosinophilia. Data were extracted from electronic medical records including: patient demographics, co-morbidities, medications, endoscopic findings, treatment, and outcomes (symptomatic, endoscopic, and histologic response). Descriptive statistics were used to characterize patients diagnosed with EGE and bivariate analysis was performed to compare adults (≥18 yrs) and children. Results: There were 44 patients diagnosed with EGE (mean age 16 yrs; 58% male; 58% white). The most common presenting symptoms were vomiting (71%) and abdominal pain (62%). Food allergies were noted in 42%, and 64% had a family history of atopic disease. There were few differences between children and adults (see Table 1). Of the EGE cases, 12 (30%) had both gastric and duodenal involvement, 18 (45%) had gastric involvement only, 10 (25%) had duodenal involvement only, 12 (30%) had overlapping eosinophilic esophagitis (EoE), and 11 (28%) had overlapping eosinophilic colitis (EC). Average eosinophil counts were 61, 55, 56, and 84 for the stomach, duodenum, esophagus, and colon respectively. For treatment, 36 (80%) received corticosteroids, 21 (47%) had dietary restriction, and 34 (76%) required >1 treatment modality. Overall, 27 (60%) had symptom resolution and 23 (51%) had endoscopic resolution, with higher response rates noted for oral steroids than for diet modification, leukotriene antagonists, H2 blockers, or mast-cell inhibitors. For diagnosis and treatment monitoring, EGE cases underwent a mean of 5 endoscopic procedures per year. Conclusion: EGE presents with non-specific GI symptoms, and in almost one-third of cases overlaps with either EoE or EC. It remains difficult to treat, with only just over half of patients responding to treatment. Management of EGE is resource intensive, with high rates of endoscopic utilization. Comparison of adults and children (<18 yrs) with eosinophilic gastroenteritis
Mo1853 Low Prevalence of Eosinophilic Esophagitis in Hispanics and Asians in the United States Robert M. Genta, Stuart J. Spechler Introduction: National differences in the prevalence of eosinophilic esophagitis (EoE) have been described, but it is not clear whether these differences are real (due to differences in genetic or environmental factors) or spurious (due to national differences in awareness of the condition among physicians and in their recognition of the endoscopic and histological features of EoE). Prevalence rates for EoE in reports from Asia have been highly variable (e.g., 0.01% in a study from Japan, 0.34% in a study from China, 6.6% in a study from Korea). To minimize confounding due to national differences in physician factors relating to the diagnosis of EoE, we estimated the prevalence of EoE in patients of different ethnicities who had endoscopy performed in the U.S. with esophageal biopsies evaluated by a group of gastrointestinal pathologists in the U.S. Methods: Using a large national pathology database, which includes demographic, clinical, endoscopic and histopathological data from patients who have endoscopic procedures with biopsies in outpatient endoscopy centers throughout the U.S., we categorized all patients who had esophageal biopsies according to their ethnic origin as follows: Hispanics, Japanese, other East Asians (Koreans, Chinese, and Vietnamese), Indians, and Other Americans (mostly Caucasians and African-Americans). We then evaluated the prevalence of EoE as diagnosed by: 1) histological evaluation of esophageal biopsy specimens showing ≥15 eosinophils per high power field, and 2) clinical data (symptoms and/or endoscopic findings) compatible with EoE. Comparisons were made using unadjusted odds ratios. Results: We identified a total of 77,788 unique patients who had esophageal biopsy specimens including 18,685 Hispanics (median age 54 years; 43% male), 4,071 East Asians (median age 56 years; 46% male), 272 Japanese (median age 59; 48% male), 1,840 Indians (median age 52 years, 55% male), and 52,920 Other Americans (median age 57 years; 47% male). The prevalence of EoE in each group is depicted in Figure 1. Note that the prevalence of EoE in Hispanics and East Asians is less than half that in Other Americans. Conclusions: There appear to be significant differences in the prevalence of EoE among different ethnic groups in the U.S., with especially low prevalence rates in Hispanics and East Asians.
Mo1855 When Eosinophilic Esophagitis Is Refractory to Topical Steroids: Treatment Options and Clinical Outcomes Cary C. Cotton, Daniel J. Green, Julia T. Hughes, W. Asher Wolf, John T. Woosley, Nicholas J. Shaheen, Evan S. Dellon Background: Topical steroids are the first-line pharmacologic agents for treatment of eosinophilic esophagitis (EoE). For patients who do not respond to these medications, treatment regimens are not standardized, and outcomes of second-line therapies are poorly described. Aim: To assess the treatment outcomes for patients unresponsive to topical steroid therapy for EoE. Methods: This was a retrospective cohort study of the University of North Carolina EoE Clinicopathologic database from 2001-2013. Subjects with an incident diagnosis of EoE who met consensus guidelines were included. All had symptoms of esophageal dysfunction, ≥15 eos/hpf (hpf area=0.24 mm2), and did not respond to a PPI trial. Patients who were treated with 2 months of a topical steroid (fluticasone 880-1760mcg/day or budesonide 1-2mg/day) were identified. Demographic and pre/post treatment symptom (patient-reported global improvement), endoscopic (endoscopist-reported improvement), and histologic data were extracted from medical records. To identify the most difficult to treat group, we defined refractory patients as having ≥30 eos/hpf with either persistent symptoms or persistent endoscopic findings after topical steroids. Treatments subsequent to the topical steroids were recorded, and outcomes were assessed. Successful rescue therapy was defined as <15 eos/hpf. Results: Of the 307 EoE patients treated with topical steroids, 155 had complete symptomatic, endoscopic, and histologic data, and 51 (mean age 24, 69% male, 76% white, mean baseline 80 eos/hpf, post-steroid 78 eos/hpf) met our refractory criteria. In 4 of these patients, lack of response was due to non-adherence, and follow-up data were available on
Percentage of unique patients with esophageal biopsies with a histopathologic diagnosis of EoE. Odds Ratios relative to the group "Other Americans" are depicted on top of each bar. Other Americans included Caucasian and African American patients; East Asians included subjects of Chinese, Korean, and Vietnamese origin. Indians included patients with ancestry in the Indian Subcontinent.
S-673
AGA Abstracts
AGA Abstracts
Clinical Characteristics, Treatment Outcomes, and Resource Utilization in Children and Adults With Eosinophilic Gastroenteritis Craig Reed, John T. Woosley, Evan S. Dellon