title: Gender is a determinative factor in the initial clinical presentation of eosinophilic esophagitis.
abstract: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease resulting in symptoms of esophageal dysmotility. Abnormalities include dysphagia, food impaction and reflux. Although men appear to comprise a majority of the EoE population, few studies have directly assessed gender-associated clinical differences. The aim of this study is to identify the effect of gender on the initial clinical presentation of adult-onset EoE patients. We reviewed our electronic medical record database from January 2008 to December 2011 for adults diagnosed with EoE per the 2011 updated consensus guidelines. Patient demographics, presenting symptoms, endoscopy findings and complications were recorded. Proportions were compared using chi-squared analysis, and means were compared using the Student's t-test. A total of 162 patients met the inclusion criteria and 71 (44%) were women. Women were more likely to report chest pain (P = 0.03) and heartburn (P = 0.06), whereas men more commonly reported dysphagia (P = 0.04) and a history of food impaction (P = 0.05). Endoscopic findings were similar between groups. No patients suffered esophageal perforations. These data suggest that men report more fibrostenotic symptoms and women report more inflammatory symptoms at the time of diagnosis. There was no difference in endoscopic findings between genders. This is one of the only reviews comparing differences in clinical presentation, endoscopic findings and complications between gender for EoE. The current recommended guidelines state that any patient with symptoms of esophageal dysfunction should be biopsied for EoE. Our findings support biopsying patients with typical and atypical symptoms of dysmotility including heartburn and chest pain.
authors.affiliation: Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Lynch
authors.affiliation: Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dhalla
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: V
authors.initials: V
authors.lastname: Chedid
authors.affiliation: Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Ravich
authors.affiliation: Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Stein
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Montgomery
authors.affiliation: Division of Allergy & Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Bochner
authors.affiliation: Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: J O
authors.initials: JO
authors.lastname: Clarke
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000473:pathology*; D015154:Esophageal Motility Disorders / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006356:Heartburn / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors
keywords: dysphagia; eosinophilic esophagitis; food impaction