Prevalence of eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease symptoms: A prospective study.
BACKGROUND
Eosinophilic esophagitis (EoE) is not routinely considered in the differential diagnosis of refractory gastroesophageal reflux disease (GERD).


OBJECTIVE
To prospectively evaluate the prevalence of EoE and describe the clinical features and predictors of EoE in patients with refractory symptoms of GERD.


METHODS
Esophageal biopsies were obtained in patients with symptoms of GERD refractory to 8 weeks of conventional antisecretory therapy. Diagnosis of EoE was defined as at least 20 eosinophils × high power field and clinical unresponsiveness to proton pump inhibitors. Clinical and manometric features were compared. Independent risk factors predicting EoE were identified.


RESULTS
Six out of 150 included patients (4%) met the diagnostic criteria for EoE. Patients with EoE were significantly younger, had significantly more dysphagia, atopy, ineffective esophageal peristalsis, esophageal rings and esophageal strictures than patients without EoE. Independent predictors of EoE were: age under 45 years (OR 4.8, 95% CI 2.4-8.6), dysphagia (OR 12.2, 95% CI 4.3-19.4), and atopy (OR 3.4, 95% CI 1.5-7.4).


CONCLUSIONS
EoE is an uncommon condition (4%) in patients with refractory symptoms of GERD. Age under 45 years, atopy or dysphagia may warrant suspicion of EoE in this subset of patients.
García-Compeán
Diego
D
Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. Jose E. González and Faculty of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, N.L., Mexico.
González González
José Alberto
JA
Marrufo García
César Antonio
CA
Flores Gutiérrez
Juan Pablo
JP
Barboza Quintana
Oralia
O
Galindo Rodríguez
Gabriela
G
Mar Ruiz
Miguel Angel
MA
de León Valdez
David
D
Jaquez Quintana
Joel Omar
JO
Maldonado Garza
Héctor Jesús
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult