Abstract
Objectives
Eosinophilic esophagitis (EoE) is an emerging chronic immune-mediated esophageal disease
characterized by eosinophilic infiltration of the esophageal mucosa. In India, the
prevalence and predictors of EoE in patients presenting with gastroesophageal reflux
symptoms remain inadequately explored. This article determines the prevalence of EoE
in adult patients with esophageal symptoms and identifies potential clinical, endoscopic,
and hematologic predictors of EoE.
Materials and Methods
A prospective observational study was conducted at a tertiary care gastroenterology
outpatient clinic between April 2023 and December 2024. Consecutive adult patients
presenting with esophageal symptoms underwent esophagogastroduodenoscopy with targeted
esophageal biopsies. Histopathological examination for mucosal eosinophilia (≥ 15
eosinophils per high-power field) was performed. Demographic, clinical, hematologic,
and endoscopic parameters were analyzed to identify predictors of EoE.
Results
Among 350 screened patients, 4 (1.14%) were diagnosed with EoE. EoE patients were
predominantly male with a mean age of 39.6 ± 4.2 years and had a higher prevalence
of allergic history (75%) compared with non-EoE subjects (5.2%, p = 0.003). Nonresponse to proton-pump inhibitors (PPIs) was significantly associated
with EoE (p = 0.001). Peripheral absolute eosinophil counts were elevated in EoE cases (median
410/mm3) compared with non-EoE cases (median 162/mm3, p = 0.02). Endoscopic features such as esophageal rings and linear furrows were noted
in some EoE cases. Multivariate analysis identified allergy history and PPI nonresponsiveness
as significant independent predictors of EoE.
Conclusion
The prevalence of EoE among Indian adults with esophageal symptoms is low (1.14%).
However, a personal history of allergy, elevated peripheral eosinophil count, and
poor response to PPI therapy are significant predictors of EoE. Early recognition
of these factors can facilitate targeted biopsy and accurate diagnosis of EoE in clinical
practice.
Keywords
eosinophilic esophagitis - esophageal biopsy - gastroesophageal reflux
