Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
United European Gastroenterol J. 2014 Apr;2(2):69-76. doi: 10.1177/2050640614525152.
Eosinophilic oesophagitis (EoO) has been associated with allergic disorders as well as aeroallergens. The current literature has shown a possible association between seasonal variation, mainly in the spring, and the incidence of EoO. However, this data was based on small population studies that did not exclude proton-pump inhibitor (PPI)-responsive oesophageal eosinophilia (PPI-ROE) in their cohort.
The aim of this study was to determine if there is a seasonal variation associated with the diagnosis of EoO in patients that had been treated with high-dose PPI prior to diagnosis.
Oesophageal biopsies were obtained from a cohort of patients who presented with symptoms of dysphagia, odynophagia, and heartburn during a 10-year period. Symptomatic patients who had biopsies from the mid and distal oesophagus with ≥20 eosinophils per high-power field (hpf) while on high-dose PPI treatment for at least 5 weeks were diagnosed as having EoO. The monthly and seasonal incidences were determined (winter, January-March; spring, April-June; summer, July-September; Autumn, October-December).
A total of 20,718 patients were identified and their records evaluated. From this cohort, 193 (0.93%) symptomatic patients had biopsy-proven oesophageal eosinophilia (≥20 eosinophils/hpf) and no seasonal variation was seen in this group. However, only 57 (0.28%) had been adequately treated with PPI prior to diagnosis (i.e. non-PPI-ROE biopsy-proven EoO; ≥20 eosinophils/hpf: 39 males, 18 females; age 29.5 years). The most common medical history components included asthma (12.3%) and food allergies (3.5%), and the most common presenting symptoms included dysphagia (50.9%) and heartburn (26.3%). The monthly and seasonal incidences in our cohort were with no apparent trend (p = 0.713 and 0.703, respectively).
The incidence of EoO was consistent across all 12 months as well as during the four seasons. Our data does not support a seasonal variation in relation to the incidence of EoO in the US midwestern non-PPI-ROE population.
嗜酸性食管炎（EoO）与过敏疾病以及空气过敏原有关。目前的文献表明，主要在春季的季节性变化与 EoO 的发病率之间可能存在关联。然而，这些数据基于没有排除其队列中质子泵抑制剂（PPI）反应性食管嗜酸性粒细胞增多症（PPI-ROE）的小人群研究。
本研究旨在确定在接受高剂量 PPI 治疗诊断之前，诊断为 EoO 的患者是否与季节性变化有关。
在 10 年期间，从出现吞咽困难、咽痛和烧心症状的患者中获得食管活检。在接受高剂量 PPI 治疗至少 5 周时，具有≥20 个高倍镜视野（hpf）食管嗜酸性粒细胞的中远端食管活检的症状性患者被诊断为患有 EoO。确定了每月和季节性的发病率（冬季，1 月至 3 月；春季，4 月至 6 月；夏季，7 月至 9 月；秋季，10 月至 12 月）。
共确定了 20,718 名患者并对其记录进行了评估。在此队列中，有 193 名（0.93%）有症状的患者有活检证实的食管嗜酸性粒细胞增多症（≥20 个嗜酸性粒细胞/hpf），但在该组中未观察到季节性变化。然而，只有 57 名（0.28%）在诊断前得到了充分的 PPI 治疗（即非 PPI-ROE 活检证实的 EoO；≥20 个嗜酸性粒细胞/hpf：39 名男性，18 名女性；年龄 29.5 岁）。最常见的病史成分包括哮喘（12.3%）和食物过敏（3.5%），最常见的症状包括吞咽困难（50.9%）和烧心（26.3%）。我们队列中的每月和季节性发病率没有明显趋势（p=0.713 和 0.703）。
EoO 的发病率在所有 12 个月以及四个季节中均保持一致。我们的数据不支持与美国中西部非 PPI-ROE 人群中 EoO 的发病率有关的季节性变化。
