Epidemiology, Clinical Presentation, and Seasonal Variation in the Diagnosis of Children with Eosinophilic Esophagitis in Oklahoma

Abstract

Objectives: Eosinophilic esophagitis (EoE) is characterized by upper gastrointestinal tract symptoms in association with esophageal mucosal biopsy specimens containing ≥15 intraepithelial eosinophils per high-power field. The etiology of EoE remains unclear, but an immunologic response to various foods and aeroallergens has been implicated. Seasonal variation has been reported in the diagnosis of EoE. The epidemiology and seasonal variation of EoE has never been studied in Oklahoma. The aim of this retrospective study was to determine epidemiology, clinical presentation, and seasonal variation of EoE in children seen from 2008 to 2015 at The Children's Hospital at Oklahoma University Medical Center (OUMC).

Methods: This was a single-center study involving the medical records of children aged 0 to 18 years with a diagnosis of EoE at OUMC in the Department of Pediatric Gastroenterology from January 2008 to December 2015. All charts with "eosinophilic esophagitis" in the diagnostic search history were reviewed. A diagnosis of EoE was defined as presence of ≥15 eosinophils per high-power field in the esophageal mucosal biopsy. The data extracted from the medical records included demographics, previous proton pump inhibitor use prediagnosis, clinical presentation, blood and skin allergy testing, and month of diagnosis. Seasons were distributed as spring (March-May), summer (June-August), fall (September-November), and winter (December-February).

Results: Seventy-nine patients with a diagnosis of EoE were seen at OUMC between 2008 and 2015. One patient was excluded because of insufficient medical records. The average age (±standard deviation) at diagnosis was 7.5 (±4.92) years with an age range of 1 to 17 years. χ² analysis showed a significant sex distribution, with 72% males and 27% females (P = 0.0001). The most common presenting symptoms were dysphagia (35%) and vomiting (28%). When patients were grouped seasonally using the χ² test, there was an increase in the diagnosis of EoE cases during the spring months when compared with other seasons (P = 0.0006). Forty-five percent of patients were diagnosed in the spring, 22% in the fall, 19% in the summer, and 14% in the winter.

Conclusions: Our data demonstrate that there is a seasonal variation in the diagnosis of EoE, with more cases diagnosed in the spring months. These findings relate to the increase in aeroallergens and pollen distribution during the spring months in Oklahoma.