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Features of eosinophilic esophagitis may differ by race, sex
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Race and sex should be considered when observing clinical symptoms and endoscopic features of eosinophilic esophagitis, according to a recent multicenter, cross-sectional study. African-American patients with EoE may present with fewer typical findings compared with white patients.
“Differences in the clinical presentation of EoE had been observed both by gender and by race in single center studies, but these observations were sometimes conflicting, which may have been related to variability in patient populations between individual centers,” Evan S. Dellon, MD, from the University of North Carolina School of Medicine, told Healio Gastroenterology. “The present study generated a large sample of both children and adults with EoE from five centers across the U.S.”
Evan S. Dellon
Dellon, along with Fouad J. Moawad, MD, from Walter Reed National Military Medical Center, and colleagues examined EoE cases in both adult and pediatric patients with various racial backgrounds (83% white; 10% African American; and 7% other races). Registries of five U.S. institutions — Walter Reed National Military Medical Center, University of North Carolina, Indiana University, Mayo Clinic in Jacksonville, and Icahn School of Medicine at Mount Sinai — were used in the retrospective, multicenter, cross-sectional analysis.
Of the 793 patients included in the study, 72% of the patients were men. There were 476 adults with a median age of 38 years and 317 children with a median age of 8 years. EoE cases were all defined by consensus guidelines.
Researchers found that a higher proportion of men had strictures, compared to women (17% vs 11%; P = .038), while clinical presentations, histories of atopy, findings from endoscopy, and histologic characteristics were found to be similar between male and female patients.
In regard to race, the researchers found that more white patients proportionately had the following typical findings compared to African Americans and other races: dysphagia (74%, 56%, and 53%, respectively; P < .001), food impaction (35%, 13%, and 13%, respectively; P < .001), and features of EoE that included rings (46%, 25%, and 18%, respectively; P < .001) or furrows (70%, 58%, and 55%, respectively; P = .012).
“While men and women with EoE largely had similar clinical and endoscopic characteristics (with the exception that men had a longer symptom duration and were more likely to have esophageal strictures), there were important differences by race,” Dellon said. “For example, African-Americans and other races were less likely to present with classic symptoms of dysphagia than their white counterparts. This has important clinical implications. While EoE is still more common in whites than in other races, it is important to consider this diagnosis in African-Americans and other races, even if the symptoms and clinical presentation are not always typical for EoE. If there is not a high level of suspicion for this condition and esophageal biopsies are not obtained, the diagnosis could be missed in these populations.”
Disclosures: Dellon reports he is a consultant for Aptalis, Novartis, Receptos, Regeneron, and Roche; received research funding from Meritage and Receptos; and received an educational grant from Diagnovus. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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