title: Prevalence of eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease symptoms: A prospective study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Diego
authors.initials: D
authors.lastname: García-Compeán
authors.forename: José Alberto
authors.initials: JA
authors.lastname: González González
authors.forename: César Antonio
authors.initials: CA
authors.lastname: Marrufo García
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Flores Gutiérrez
authors.forename: Oralia
authors.initials: O
authors.lastname: Barboza Quintana
authors.forename: Gabriela
authors.initials: G
authors.lastname: Galindo Rodríguez
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Mar Ruiz
authors.forename: David
authors.initials: D
authors.lastname: de León Valdez
authors.forename: Joel Omar
authors.initials: JO
authors.lastname: Jaquez Quintana
authors.forename: Héctor Jesús
authors.initials: HJ
authors.lastname: Maldonado Garza
mesh_terms: 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