Researcher seeks to better understand how eosinophilic GI disorders impact women’s health

Key takeaways:

• The most common symptom of EoE before pregnancy was dysphagia, followed by reflux and pain.
• Half of the patients in the cohort had worsening of EoE symptoms after pregnancy.

Improving understanding of eosinophilic gastrointestinal disorders and their impact on women’s health and pregnancy has personal roots for Jenny Huang, MD, because a few years ago, she was diagnosed with eosinophilic gastritis.

“Going through the diagnosis and having the disease altered my life and shaped my clinical and research interests,” Huang, a clinical fellow in allergy and immunology at Scripps Clinic in San Diego, told Healio. “I was already working on projects within the realm of pregnancy and allergic disorders then subsequently was inspired to work on research to expand the knowledge we have on pregnancy and eosinophilic gastrointestinal disorders given the lack of data and small amount of research available.”

Because the disease course of eosinophilic esophagitis during pregnancy is not well understood, Huang and her colleague, Andrew A. White, MD, of the division of allergy, asthma and immunology at Scripps Clinic, sought to characterize the symptoms and treatment of patients with EoE before, during and after pregnancy, in a study published in The Journal of Allergy and Clinical Immunology: In Practice.

Although EoE has previously been thought of as a male-predominant disorder, women, especially those of child-bearing age, represent a significant proportion of patients who have EoE, with a prevalence of 32.83 cases per 100,000, according to data cited by Huang and White.

“While there are treatment options available, there are so little data to guide management in pregnant patients,” Huang said. “We need to learn more about how pregnancy affects EoE and vice versa in order to better counsel patients and provide useful anticipatory guidance when our patients become pregnant.”

EoE symptoms, treatment in pregnancy

Huang and White conducted a retrospective, observational study of 12 patients who had EoE and pregnancy-related diagnoses. The average age at EoE diagnosis was 33.3 years (range, 27-43), and the average age at the relevant pregnancy was 34.5 years (range, 29-42).

Ten patients had allergic comorbidities, most often allergic rhinitis, and seven had a peak peripheral eosinophil count greater than 500 cells/µL.

The researchers reported that the most common symptoms before pregnancy were dysphagia (n = 7), by reflux (n = 6) and pain (n = 6).

“It must be noted that reflux, burning and other gastrointestinal symptoms are very common during pregnancy, and so it is difficult to ascertain whether reported symptoms are due only to EoE or, more likely, a combination of EoE and pregnancy,” the researchers wrote.

Overall, eight patients were on proton pump inhibitors before pregnancy, making it the most commonly used therapy.

After becoming pregnant, five patients reported their symptoms improved, whereas three reported worsening symptoms, two reported unchanged symptoms and two had an unreported symptom burden.

“In this small cohort, EoE symptoms worsened, improved or remained unchanged — an observation that has been noted in asthma as well,” the researchers wrote.

During pregnancy, five patients decreased pharmacotherapy; this included stopping treatment completely or switching to an empiric elimination diet, according to the researchers.

“Pregnant patients express hesitancy over taking medications for EoE during pregnancy, and this can result in self-discontinuation of medications and worse outcomes,” the researchers wrote. “For the patients who chose to decrease pharmacotherapy, most of them did so as soon as they became pregnant, indicating a need to discuss the safety of treatments before pregnancy if possible.”

After pregnancy, dysphagia returned in two patients who had improvement during pregnancy, and one patient developed new dysphagia.

Additionally, six patients reported worsening symptoms and two patients reported unchanged symptoms.

The researchers also noted that four patients had a food impaction within the first 6 months postpartum.

Next steps

In addition to studying EoE during pregnancy, Huang also plans to study how pregnancy affects other eosinophilic gastrointestinal disorders, such as eosinophilic gastritis, eosinophilic duodenitis, eosinophilic enteritis and eosinophilic colitis.

“These diseases are considered to be rare, but I believe they are also underdiagnosed, which is another big area of advocacy and research interest for me,” Huang said.

Ultimately, Huang hopes to advance knowledge in the intersection of eosinophilic gastrointestinal disorders and women’s health.

“This includes how the diseases are different for women compared with men, how pregnancy affects these diseases and the safety of treatments during pregnancy,” she said.

For more information:

Jenny Huang, MD, can be reached at huang.jenny@scrippshealth.org.