Patients with allergic diseases may have a high prevalence of coexisting eosinophilic esophagitis compared to the general population, suggests a study published in The Journal of Allergy and Clinical Immunology: In Practice.^1,2 These patients also have gastrointestinal symptoms in addition to the allergic symptoms.

One hundred adults in the age group 27-48 years attending a tertiary care allergy clinic with complaints of allergic rhinitis, asthma, atopic dermatitis or IgE-mediated food allergy between February and October 2021 were recruited for this study. The participants were instructed to answer the PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire.

Results showed that the major GI symptoms experienced at least once in the past week were reflux, pain in the abdomen and difficulty swallowing solid foods. Data analysis showed that 18.6% participants experienced nausea or vomiting, 43% had at least one episode of reflux in the preceding week, 42% reported one episode of pain in the abdomen in the last week and 38.5% complained of solid food dysphagia at least once in the previous 7 days. Ten percent of patients reported at least one esophageal food impaction in the previous year, while 7% experienced food impaction on more than one occasion.

Forty-four of the 100 participants had the typical symptoms of eosinophilic esophagitis such as dysphagia and food impaction, 37 had atypical symptoms such as exercise-induced chest pain, while 19 were asymptomatic. Five patients with the typical symptoms underwent  the Cytosponge procedure with retrieval of cells from the esophageal wall for analysis. One of these five tested positive for eosinophilic esophagitis confirmed on endoscopy after two weeks.

Two out of 3 patients with typical symptoms of eosinophilic esophagitis who underwent endoscopy but not the Cytosponge procedure were found to have eosinophilic esophagitis. Among the atypical symptoms group, five patients who had the Cytosponge procedure did not have eosinophilic esophagitis.

When only the results of the Cytosponge procedure were taken into consideration, the prevalence of eosinophilic esophagitis was around 9%. But when patients who underwent esophagogastroduodenoscopy were added to this analysis, the prevalence rose to 16.5%.

These findings indicate the high prevalence of gastrointestinal symptoms in patients with allergic conditions who were not diagnosed with eosinophilic esophagitis. Nearly 10% of the participants were found to have eosinophilic esophagitis. Hence, clinicians managing allergic diseases should also ask about GI symptoms, especially dysphagia, in routine evaluation as eosinophilic esophagitis may occur simultaneously. “Solid food impactions are a known complication of untreated EoE due to changes in the esophageal mucosa”, note the authors.³ And if present, these patients should be referred for appropriate investigations to confirm the diagnosis and initiate treatment.

References

1. Eid R, et al. High prevalence of gastrointestinal symptoms and undiagnosed eosinophilic esophagitis among allergic adults. J Allergy Clin Immunol Pract. 2022 Sep 29;S2213-2198(22)00966-7.
2. https://www.healio.com/news/allergy-asthma/20221130/gastrointestinal-symptoms-may-indicate-eosinophilic-esophagitis-among-adults-with-atopy, November 30, 2022.
3. https://www.ajmc.com/view/patients-with-asthma-other-allergic-diseases-may-have-higher-prevalence-of-eoe, October 18, 2022.