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Eosinophilic Esophagitis—Emerging Epidemic or Misdiagnosed Malady?

Published:November 11, 2013DOI:https://doi.org/10.1016/j.cgh.2013.10.036
      Eosinophilic esophagitis (EoE) is a recently recognized, clinicopathologic disorder characterized by esophageal mucosal eosinophilia in association with dysphagia. EoE was first described in a few case reports in adults in the 1980s. It was first characterized as an entity seemingly distinct from gastroesophageal reflux disease in 2 small case series of adults in the early 1990s. Ironically, over the next decade, EoE was mainly viewed as a childhood disease, owing to large cohorts and prospective trials emerging from pediatric centers in the United States. This earlier appreciation by pediatricians has been partly attributed to their more routine clinical practice of obtaining esophageal biopsies at the time of upper endoscopic procedures.
      • Shah A.
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      Histopathologic variability in children with eosinophilic esophagitis.
      A more recent single-center study reported that 2.3% of adult patients presenting for endoscopy have esophageal eosinophilia and of these ∼79% had definitive or probable EoE.
      • Sealock R.J.
      • Kramer J.R.
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      The prevalence of oesophageal eosinophilia and eosinophilic oesophagitis: a prospective study in unselected patients presenting to endoscopy.
      Recent pediatric and adult prevalence estimates of 43–91 cases per 100,000 have been reported from referral centers caring for patients within restricted catchment areas, including Hamilton county, Ohio, Olmstead county, Minnesota, and Olten county, Switzerland.
      • Hruz P.
      • Straumann A.
      • Bussmann C.
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      Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland.
      • Prasad G.A.
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      Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota.
      • Buckmeier B.
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      The incidence and prevalence of eosinophilic esophagitis.
      The highest prevalence estimate reported of 1 case per 1000 is notable in that the cohort, unlike other population studies, was limited to pediatric cases.
      • Buckmeier B.
      • Rothenberg M.
      • Collins M.
      The incidence and prevalence of eosinophilic esophagitis.
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      1. 107th Congress. Rare Disease Act of 2002 Public Law 107–280.

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