Background: Eosinophilic esophagitis (EoE) has been described as a chronic allergen/immune-mediated disease characterized by symptoms of esophageal dysfunction and eosinophilic infiltration of the mucosa. Summary: Over the past decades, EoE has been increasingly recognized in various geographical areas with a high socioeconomic development (mostly industrialized countries) and has evolved from an unknown to a clinically distinct disease with increasing prevalence and incidence. An average age at diagnosis between 30 and 50 years and a male predominance have been consistently observed. In both children and adults, EoE is clearly associated with allergies, predominantly food – but also aeroallergens. Most EoE patients present with a personal allergic background such as asthma, rhino-conjunctivitis, and oral allergy syndrome. Key Message: Knowledge of epidemiological characteristics is crucial for identifying risk factors and understanding of the pathogenic mechanisms.

Thirty years ago, eosinophilic esophagitis (EoE) was described as a new immune-mediated inflammatory disorder of the esophagus characterized by esophageal symptoms in combination with a dense esophageal eosinophilia [1, 2]. Over the past 3 decades, an increasing incidence and prevalence has been described in the literature. However, most of the epidemiological information on EoE was based on retrospective evaluation of pathology reports with reexamination of biopsy specimens, analysis of endoscopy databases or surveys [3‒9]. In recent years, population-based epidemiological information from geographically confined regions with longitudinal analysis has provided more substantial information on the characteristics and course of the disease. The aim of the current review was to address epidemiological key characteristics, such as the incidence and prevalence of EoE, and to describe demographic characteristics of EoE and disease associated factors.

Following the updated 2018 guidelines, EoE should be diagnosed when symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field on esophageal biopsy are present after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia [10]. Generally, eosinophils are present in the mucosa of all segments of the digestive tract, except the esophagus [11, 12]. Therefore, the presence of eosinophils in the esophagus is commonly associated with disease and requires a process of differential diagnosis. Data from a population-based study found a prevalence of 4.8% of any esophageal eosinophils in the distal part of the esophagus in the general population and was associated with erosive esophagitis and hiatal hernia [12]. This suggests that eosinophils may be present in the esophagus in the general population and may not generally be associated with EoE. Besides EoE, eosinophilic infiltration of the esophagus has been reported in patients having gastroesophageal reflux disease, Barrett’s esophagus, and rare conditions such as drug-induced esophagitis, bacterial and parasitic infection, vasculitis, Crohn’s disease, and eosinophilic gastroenteritis with affection of the esophagus [11].

Global Incidence and Prevalence of EoE

In 2016, one of the first systematic reviews for EoE with a total of 13 population-based studies from North America, Europe, and Australia was published: a pooled prevalence rate of 22.7 cases per 100,000 inhabitant-years and a pooled incidence rate of 3.7 cases per 100,000 inhabitant-years was calculated [13]. A steady increase in EoE incidence and prevalence rates has been observed comparing studies conducted before and after 2008, and higher prevalence rates in American compared to European studies have been shown. The variability may be partly explained by differences in access to endoscopic resources and physician awareness. Data on the epidemiology of EoE in Central and South America, Asia, and North Africa are still scarce.

A recent systematic review showed comparable data: a slightly higher pooled prevalence of 34.4/100,000 and a pooled incidence of 7.7/100,000 in adults and 6.6/100,000 in children, respectively, was calculated [14]. A steady increase in the incidence and prevalence of EoE over time was observed as well. This trend was further confirmed by another meta-analysis including a total of 40 studies from 15 different countries and around 150,000 EoE patients, showing a steadily increasing global EoE prevalence between 1976 and 2022 [15]. In addition, a higher incidence and prevalence of EoE in high-income regions of North America and Europe compared to middle- and low-income regions was observed in this analysis.

Time Trends in Incidence and Prevalence of EoE in Geographically Confined Regions

In Canton of Vaud (Switzerland), a steady increase over the past 10 years up to an incidence of 6.3/100,000 and a cumulative prevalence of 24.1/100,000 in 2013 was demonstrated [16]. This observation confirmed earlier studies from the confined region of Olten County (Switzerland), with increasing cumulative incidence (7.4/100,000) and prevalence rates (42.1/100,000) [17]. Similar findings have been observed in a confined region in Spain with a cumulative incidence rate reaching 10/100,000 and a cumulative prevalence rate of 106/100,000 persons/year (children and adult rates combined) [18]. Two independent nationwide analyses in North America reported estimated prevalence rates of 50.6/100,000 [19] and 25.9/100,000 [20], respectively. The difference between the two US-American studies may be due to differences in the case definition and unequal population sizes. In the second analysis, only patients with a diagnosis of EoE and a history of proton pump inhibitor use were included, to avoid cases of proton pump inhibitor-responsive esophageal eosinophilia.

Recently, a systematic review and meta-analysis on the incidence and prevalence of EoE in Europe showed an overall prevalence across all studies of 32.7/100,000 and an incidence of 4.1/100,000 with the highest incidence values reported from confined areas of Spain [21]. All studies that reported longitudinal trends in EoE incidence showed an increase over time, more marked in recent years. These findings of increasing incidence and prevalence rates were also confirmed in register-based pathology reports from the Netherlands, Sweden, and Denmark [22‒24]. Generally, it seems that the incidence rates were lower in nationwide studies compared to regional or center-based studies. This cannot be explained solely by increased awareness for the disease amongst health care professionals in different regions worldwide, as the epidemiological trend behaved disproportionately compared to the increase in esophageal biopsies over time [25]. As this awareness has only grown in the last 10–20 years, the numbers of EoE diagnoses have risen at different points in time. On the other hand, different methods of data collection and evaluation may also play a role, for example, the inclusion or exclusion of patients with proton pump inhibitor-responsive esophageal eosinophilia. Retrospective studies on old biopsy blocks did not reveal a considerable amount of missed EoE diagnoses in previous time periods [25]. Furthermore, it should also be considered and further investigated whether EoE develops differently in different regions due to genetic and environmental factors. Independently of these considerations, an increase in the incidence and overall prevalence of EoE cases in Europe over the last 30 years was demonstrated.

Diagnostic Delay and Risks

A recent population-based study calculated a median diagnostic delay of 4 years in adult patients and 2 years in pediatric patients and found that the median diagnostic delay did not change significantly over the past 10 years [16]. This is of clinical relevance as Danish cohort data indicated that the complicated EoE phenotype is associated with a longer diagnostic delay [26].

This finding is supported by a recent analysis that showed decreased esophageal distensibility and compliance in adult EoE patients with longer symptom duration prior to their diagnosis [27]. The association between reduced distensibility and increased symptom duration supports the findings of a previously reported prediction model that the risk of developing fibro-stenotic disease more than doubles per decade of life [28]. It also fits with prior clinical studies assessing longitudinal course of EoE, which concluded that the prevalence of esophageal strictures correlates with the duration of untreated disease [29‒31]. Thus, reduced esophageal distensibility can be associated with diagnostic delay and can have an important impact on disease progression in patients with EoE.

Age Distribution

Most studies report the highest prevalence and incidence rates of EoE in middle-aged adults (30–50 years of age, Table 1) [32]. Nationwide US-American and Dutch studies confirmed the peak prevalence in this age range for both genders [33]. In the USA, the prevalence rate was highest in the pediatric population (<18 years) with 25.1 as well as in the adult population (18–65 years) with 30.0, but lower in the elderly population (>65 years) with 12.8 cases per 100,000 patients, respectively [20]. Most analyses confirm a higher incidence and prevalence of EoE in adults compared to children. For example, a pooled prevalence of 42–53/100,000 inhabitants for adults and 29–34/100,000 inhabitants for children was found in the most recent worldwide systematic analyses [13‒15]. It is unclear whether the low percentage of elderly diagnosed with EoE is due to an atypical disease presentation or EoE is truly less prevalent in this age group. Another factor could be that EoE is less frequently considered as differential diagnosis in elderly patients, as it is commonly thought to be a disease of younger age [19]. In addition, it should be considered that elderly patients often belong to a patient group that is less represented and investigated in clinical studies.

Table 1.

Epidemiological characteristics of EoE patients

CharacteristicComment
Age: 30–50 years old Adults are more often affected than children 
Gender: male Male-to-female ratio of about 3:1 
Ethnicity: Caucasian Caucasians are more often affected than African Americans, Hispanics or Asians 
Clinical history: allergic disorders Asthma, allergic rhinitis, atopic dermatitis, or food allergies are most common 
Diagnostic delay (initial diagnosis) Associated with a higher risk for complicated disease 
CharacteristicComment
Age: 30–50 years old Adults are more often affected than children 
Gender: male Male-to-female ratio of about 3:1 
Ethnicity: Caucasian Caucasians are more often affected than African Americans, Hispanics or Asians 
Clinical history: allergic disorders Asthma, allergic rhinitis, atopic dermatitis, or food allergies are most common 
Diagnostic delay (initial diagnosis) Associated with a higher risk for complicated disease 

Gender and Social Parameters

The observation that male gender is a risk factor for the development of EoE both in adults and children was confirmed in many studies [32]. In the most recent global systematic review from 2023, the risk of developing EoE was found to be 3.4 times higher for men compared to women [15]. This finding could also be reproduced for patients in the USA with Caucasian males being the majority of EoE cases [19, 20]. Corresponding OR rates of 2.5, for example, in the Netherlands [22] and 2.8 in Switzerland [16] underline the increased relative risk of developing EoE among male patients.

One of the latest Swiss studies on gender-specific differences in EoE was published in 2022 and analyzed prospectively collected data of 266 adult patients. A higher endoscopic and histologic disease activity in male compared to female patients was observed, although no differences in subjective symptom severity and in EoE-associated quality of life could be demonstrated [34]. A retrospective study of 755 medical records of US-American EoE patients showed that males were diagnosed at younger age and had higher odds of having abnormal endoscopic findings compared to women [35].

Symptoms of Esophageal Dysfunction

In a systematic review in 2018, a total of 27 studies from different countries around the world (USA, Australia, Japan, Slovenia, Italy, Spain, Switzerland, and UK) have been included and showed that the most commonly described symptoms by pediatric EoE patients were emesis and abdominal pain (Table 2). In adults, the most common symptoms were solid food dysphagia and food impaction [36]. Other symptoms include reflux-like symptoms, nausea, food refusal and failure to thrive in children and non-swallowing associated chest pain or heartburn in adults [32, 37‒39]. Clinicians should also be aware of atypical manifestations of EoE, for example, exercise-induced chest pain, particularly in younger male patients [40]. In a systematic search on differences of EoE patients in Asian compared to Western countries, similar disease characteristics were found [41].

Table 2.

Symptoms associated with EoE

Age groupSymptoms
Adults Solid food dysphagia, food impaction, non-swallowing associated chest pain, heartburn, atypical presentation of exercise-induced chest pain 
Children Emesis, abdominal pain, reflux-like symptoms, nausea, regurgitation, food refusal, failure to thrive 
Age groupSymptoms
Adults Solid food dysphagia, food impaction, non-swallowing associated chest pain, heartburn, atypical presentation of exercise-induced chest pain 
Children Emesis, abdominal pain, reflux-like symptoms, nausea, regurgitation, food refusal, failure to thrive 

Allergic Predisposition

Allergic and atopic disease such as food allergies, bronchial asthma, allergic rhinitis, and atopic dermatitis are more common in EoE patients compared to the general population [42, 43]. A positive history of concurrent atopic disease has been described in 50–60% of EoE cases [32]. In a retrospective database analysis from 2009 to 2013 in the USA the following rates of concurrent diseases up to 12 months post-diagnosis were observed: atopic rhinitis in 44.7%, asthma in 27.1%, atopic dermatitis in 25.2%, and food allergies in 16.9% with almost two-third of all patients suffering from at least one of these 4 conditions [43].

Sensitization to ingested, cutaneous, and/or inhaled allergens plays an important role in the development of EoE and there is a strong consensus regarding food allergens such as milk, eggs, wheat, and soy as potential triggers for EoE [44]. Different dietary treatments show a significant and positive influence on the course of the disease. Dietary treatment options like amino acid-based elemental diets and allergy test result-directed food eliminations, but especially one-food (1-FED) up to six-food elimination diets (6-FED) showed high rates of histological remission in patients with EoE [45‒47]. The removal of one or more ingested food types, can cause resolution of disease in >50% of adult and pediatric patients. A recent multicenter trial on 6-FED (milk, wheat, egg, soy, fish/shellfish, and peanut/tree nuts) and 1-FED (milk) proved the efficacy of these approaches in terms of histological and endoscopic remission as well as clinical improvement [48].

EoE and Seasonal Distribution

In contrast to food allergens, the influence of aeroallergens has not yet been conclusively clarified. There are indications that airborne antigens play a disease modifying role in the pathogenesis of EoE [49] and some reports suggest a seasonal variation with EoE being more frequently diagnosed in the spring and summer season [50‒52]. This is further supported by the observation that EoE varies by climate zones in the USA [53]. A retrospective case series of 1,180 EoE patients found that 14% had a history of exacerbation by aeroallergens, and 20% of those had biopsy-confirmed seasonal variation of esophageal eosinophilia [54]. Mild but consistent seasonal variance with an accumulation of diagnoses (EoE and esophageal eosinophilia) in the summer months – whereby climatic and geographic differences were considered – have been reported previously [55].

A confirmation of a seasonal dependency of EoE would be an indicator that external seasonal factors, in particular, pollen could play a substantial role in the pathogenesis of this Th2-type inflammation. Indeed, one study found a significant association between peak grass pollen count and diagnosis of EoE in spring, but only a coincident association with peak tree or weed pollen counts [56]. It is important to consider that there is a substantial gap between onset of symptoms (= likely onset of disease) and endoscopic, respectively, histologic diagnosis. Also, the onset of disease often does not correlate with the date of diagnosis.

Taken together, there is currently no solid proof that either the first onset of EoE or the course of its inflammation show a seasonal variation, or that pollen exposure could play a significant pathogenic role. The current evidence does not support causality in inhalant allergen exposure and the genesis nor exacerbation of EoE in humans, although there is a possibility that inhalant allergen sensitization could play a disease modifying role in EoE in the context of cross-reacting food allergens [49]. To answer this question, prospective studies are needed using a systematic assessment of the course of symptoms as well as the inflammatory activity of EoE with a correlation to the pollen exposure.

EoE and Autoimmune-Related Conditions

An association between EoE and celiac disease (CeD) has been suggested in several case series and cohort studies [57‒60]. A prevalence of EoE in patients with CeD of 2.5–5.0% was reported in children (<18 years of age) and adults in independent reports [57, 58, 61, 62]. However, in a population-based approach with 1,000 randomly selected adults from the general population, no increased risk of CeD was found among subjects with esophageal eosinophilia, EoE or gastroesophageal reflux disease [63]. Current data do not support a true association between EoE and CeD including data from a systematic review [64]. Furthermore, gluten-free diets do not appear to induce remission of coexisting EoE in several reports and HLA DQ2 and DQ8, the predisposing alleles for CeD, were not found to be increased in adult EoE patients compared to controls [57, 61, 65]. However, it was reported that gluten-free diet resolved EoE findings in some patients, suggesting possible shared pathophysiology in some cases [66].

It has been suggested that patients with EoE had an increased risk for other autoimmune-related diseases, including ulcerative colitis and Crohn’s disease [67, 68]. An interesting propensity-matched analysis of IBD patients revealed that, when comparing patients with and without EoE, the relative risk for immune-mediated comorbidities was significantly higher for CeD, IBD-related inflammatory conditions, eczema, and asthma. Patients with a concurrent diagnosis of EoE and IBD had a higher composite risk of IBD-related complications and lower risk of food bolus impaction [69].

During the last 3 decades, the prevalence and incidence rates for EoE have steadily increased in various regions worldwide and EoE evolved from a novel to a clinically distinct disease. Better understanding of epidemiological characteristics and the clinical presentation of EoE is crucial for identifying risk factors and understanding the pathogenic mechanisms. In consequence, this will lead to identification of preventive measures and will improve treatment strategies.

The authors have no conflicts to declare regarding this article.

No relevant funding was received concerning this review article.

R.M. and P.H. contributed equally to the writing of this article.

1.
Straumann
A
,
Spichtin
HP
,
Bernoulli
R
,
Loosli
J
,
Vögtlin
J
.
[Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]
.
Schweiz Med Wochenschr
.
1994
;
124
(
33
):
1419
29
.
2.
Attwood
SEA
,
Smyrk
TC
,
Demeester
TR
,
Jones
JB
.
Esophageal eosinophilia with dysphagia
.
Dig Dis Sci
.
1993
;
38
(
1
):
109
16
.
3.
Noel
RJ
,
Putnam
PE
,
Rothenberg
ME
.
Eosinophilic esophagitis
.
N Engl J Med
.
2004
;
351
(
9
):
940
1
.
4.
DeBrosse
CW
,
Collins
MH
,
Buckmeier Butz
BK
,
Allen
CL
,
King
EC
,
Assa’ad
AH
, et al
.
Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982-1999
.
J Allergy Clin Immunol
.
2010
;
126
(
1
):
112
9
.
5.
Van Rhijn
BD
,
Verheij
J
,
Smout
AJPM
,
Bredenoord
AJ
.
Rapidly increasing incidence of eosinophilic esophagitis in a large cohort
.
Neurogastroenterol Motil
.
2013
;
25
(
1
):
47
52.e5
.
6.
Whitney-Miller
CL
,
Katzka
D
,
Furth
EE
.
Eosinophilic esophagitis: a retrospective review of esophageal biopsy specimens from 1992 to 2004 at an adult academic medical center
.
Am J Clin Pathol
.
2009
;
131
(
6
):
788
92
.
7.
Cherian
S
,
Smith
NM
,
Forbes
DA
.
Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia
.
Arch Dis Child
.
2006
;
91
(
12
):
1000
4
.
8.
Aceves
SS
,
Newbury
RO
,
Dohil
R
,
Schwimmer
J
,
Bastian
JF
.
Distinguishing eosinophilic esophagitis in pediatric patients clinical, endoscopic, and histologic features of an emerging disorder
.
J Clin Gastroenterol
.
2007
;
41
(
3
):
252
6
.
9.
Spergel
JM
,
Book
WM
,
Mays
E
,
Song
L
,
Shah
SS
,
Talley
NJ
, et al
.
Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States
.
J Pediatr Gastroenterol Nutr
.
2011
;
52
(
3
):
300
6
.
10.
Dellon
ES
,
Liacouras
CA
,
Molina-Infante
J
,
Furuta
GT
,
Spergel
JM
,
Zevit
N
, et al
.
Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference
.
Gastroenterology
.
2018
;
155
(
4
):
1022
33.e10
.
11.
Ahmad
M
,
Soetikno
RM
,
Ahmed
A
.
The differential diagnosis of eosinophilic esophagitis
.
J Clin Gastroenterol
.
2000
;
30
(
3
):
242
4
.
12.
Ronkainen
J
,
Talley
NJ
,
Aro
P
,
Storskrubb
T
,
Johansson
SE
,
Lind
T
, et al
.
Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study
.
Gut
.
2007
;
56
(
5
):
615
20
.
13.
Arias
A
,
Pérez-Martínez
I
,
Tenías
JM
,
Lucendo
AJ
.
Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies
.
Aliment Pharmacol Ther
.
2016
;
43
(
1
):
3
15
.
14.
Navarro
P
,
Arias
Á
,
Arias-González
L
,
Laserna-Mendieta
EJ
,
Ruiz-Ponce
M
,
Lucendo
AJ
.
Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies
.
Aliment Pharmacol Ther
.
2019
;
49
(
9
):
1116
25
.
15.
Hahn
JW
,
Lee
K
,
Shin
JI
,
Cho
SH
,
Turner
S
,
Shin
JU
, et al
.
Global incidence and prevalence of eosinophilic esophagitis, 1976–2022: a systematic review and meta-analysis
.
Clin Gastroenterol Hepatol
.
2023
;
21
(
13
):
3270
84.e77
.
16.
Giriens
B
,
Yan
P
,
Safroneeva
E
,
Zwahlen
M
,
Reinhard
A
,
Nydegger
A
, et al
.
Escalating incidence of eosinophilic esophagitis in Canton of Vaud, Switzerland, 1993-2013: a population-based study
.
Allergy Eur J Allergy Clin Immunol
.
2015
;
70
(
12
):
1633
9
.
17.
Hruz
P
,
Straumann
A
,
Bussmann
C
,
Heer
P
,
Simon
HU
,
Zwahlen
M
, et al
.
Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland
.
J Allergy Clin Immunol
.
2011
;
128
(
6
):
1349
50.e5
.
18.
Arias
Á
,
Lucendo
AJ
.
Incidence and prevalence of eosinophilic oesophagitis increase continiously in adults and children in Central Spain: a 12-year population-based study
.
Dig Liver Dis
.
2019
;
51
(
1
):
55
62
.
19.
Maradey-Romero
C
,
Prakash
R
,
Lewis
S
,
Perzynski
A
,
Fass
R
.
The 2011-2014 prevalence of eosinophilic oesophagitis in the elderly amongst 10 million patients in the United States
.
Aliment Pharmacol Ther
.
2015
;
41
(
10
):
1016
22
.
20.
Mansoor
E
,
Cooper
GS
.
The 2010–2015 prevalence of eosinophilic esophagitis in the USA: a population-based study
.
Dig Dis Sci
.
2016
;
61
(
10
):
2928
34
.
21.
Roberts
SE
,
Morrison-Rees
S
,
Thapar
N
,
Williams
JG
.
Incidence and prevalence of eosinophilic oesophagitis across Europe: a systematic review and meta-analysis
.
United Eur Gastroenterol J
.
2024
;
12
(
1
):
89
102
.
22.
de Rooij
WE
,
Barendsen
ME
,
Warners
MJ
,
van Rhijn
BD
,
Verheij
J
,
Bruggink
AH
, et al
.
Emerging incidence trends of eosinophilic esophagitis over 25 years: results of a nationwide register-based pathology cohort
.
Neurogastroenterol Motil
.
2021
;
33
(
7
):
e14072
.
23.
Garber
JJ
,
Lochhead
PJ
,
Uchida
AM
,
Roelstraete
B
,
Bergman
D
,
Clements
MS
, et al
.
Increasing incidence of eosinophilic esophagitis in Sweden: a nationwide population study
.
Esophagus
.
2022
;
19
(
4
):
535
41
.
24.
Allin
KH
,
Poulsen
G
,
Melgaard
D
,
Frandsen
LT
,
Jess
T
,
Krarup
AL
.
Eosinophilic oesophagitis in Denmark: population-based incidence and prevalence in a nationwide study from 2008 to 2018
.
United Eur Gastroenterol J
.
2022
;
10
(
7
):
640
50
.
25.
Dellon
ES
,
Hirano
I
.
Epidemiology and natural history of eosinophilic esophagitis
.
Gastroenterology
.
2018
;
154
(
2
):
319
32.e3
.
26.
Henriksen
SD
,
Hansen
SK
,
Heinesen
M
,
Terkelsen
JH
,
Hollænder
M
,
Bredal
K
, et al
.
The phenotype of adults with complicated eosinophilic esophagitis is dominated by a 5-year longer diagnostic delay: a population-based study of the DanEoE cohort
.
JGH Open
.
2023
;
7
(
8
):
553
8
.
27.
Araujo
IK
,
Shehata
C
,
Hirano
I
,
Gonsalves
N
,
Kahrilas
PJ
,
Tetreault
MP
, et al
.
The severity of reduced esophageal distensibility parallels eosinophilic esophagitis disease duration
.
Clin Gastroenterol Hepatol
.
2024
;
22
(
3
):
513
22.e1
.
28.
Dellon
ES
,
Kim
HP
,
Sperry
SLW
,
Rybnicek
DA
,
Woosley
JT
,
Shaheen
NJ
.
A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease
.
Gastrointest Endosc
.
2014
;
79
(
4
):
577
85.e4
.
29.
Schoepfer
AM
,
Safroneeva
E
,
Bussmann
C
,
Kuchen
T
,
Portmann
S
,
Simon
HU
, et al
.
Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner
.
Gastroenterology
.
2013
;
145
(
6
):
1230
6.e62
.
30.
Lipka
S
,
Kumar
A
,
Richter
JE
.
Impact of diagnostic delay and other risk factors on eosinophilic esophagitis phenotype and esophageal diameter
.
J Clin Gastroenterol
.
2016
;
50
(
2
):
134
40
.
31.
Warners
MJ
,
Oude Nijhuis
RAB
,
de Wijkerslooth
LRH
,
Smout
AJPM
,
Bredenoord
AJ
.
The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort
.
Am J Gastroenterol
.
2018
;
113
(
6
):
836
44
.
32.
Lucendo
AJ
,
Molina-Infante
J
,
Arias
Á
,
von Arnim
U
,
Bredenoord
AJ
,
Bussmann
C
, et al
.
Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults
.
United Eur Gastroenterol J
.
2017
;
5
(
3
):
335
58
.
33.
Dellon
ES
,
Jensen
ET
,
Martin
CF
,
Shaheen
NJ
,
Kappelman
MD
.
Prevalence of eosinophilic esophagitis in the United States
.
Clin Gastroenterol Hepatol
.
2014
;
12
(
4
):
589
96.e1
.
34.
Schreiner
P
,
Safroneeva
E
,
Rossel
JB
,
Limacher
A
,
Saner
C
,
Greuter
T
, et al
.
Sex impacts disease activity but not symptoms or quality of life in adults with eosinophilic esophagitis
.
Clin Gastroenterol Hepatol
.
2022
;
20
(
8
):
1729
38.e1
.
35.
Hiremath
G
,
Yazdian
A
,
Onuh
I
,
Willey
J
,
Choksi
Y
.
Race and gender influences the presentation of eosinophilic esophagitis HHS public access
.
Dysphagia
.
2023
;
38
(
6
):
1511
8
.
36.
Shaheen
NJ
,
Mukkada
V
,
Eichinger
CS
,
Schofield
H
,
Todorova
L
,
Falk
GW
.
Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course
.
Dis Esophagus
.
2018
;
31
(
8
):
doy015
.
37.
Straumann
A
,
Katzka
DA
.
Diagnosis and treatment of eosinophilic esophagitis
.
Gastroenterology
.
2018
;
154
(
2
):
346
59
.
38.
Gonsalves
NP
,
Aceves
SS
.
Diagnosis and treatment of eosinophilic esophagitis
.
J Allergy Clin Immunol
.
2020
;
145
(
1
):
1
7
.
39.
Biedermann
L
,
Straumann
A
,
Greuter
T
,
Schreiner
P
.
Eosinophilic esophagitis-established facts and new horizons
.
Semin Immunopathol
.
2021
;
43
(
3
):
319
35
.
40.
Kahn
J
,
Bussmann
C
,
Beglinger
C
,
Straumann
A
,
Hruz
P
.
Exercise-induced chest pain: an atypical manifestation of eosinophilic esophagitis
.
Am J Med
.
2015
;
128
(
2
):
196
9
.
41.
Kinoshita
Y
,
Ishimura
N
,
Oshima
N
,
Ishihara
S
.
Systematic review: eosinophilic esophagitis in Asian countries
.
World J Gastroenterol
.
2015
;
21
(
27
):
8433
40
.
42.
González-Cervera
J
,
Arias
Á
,
Redondo-González
O
,
Cano-Mollinedo
MM
,
Terreehorst
I
,
Lucendo
AJ
.
Association between atopic manifestations and eosinophilic esophagitis: a systematic review and meta-analysis
.
Ann Allergy Asthma Immunol
.
2017
;
118
(
5
):
582
90.e2
.
43.
Benninger
MS
,
Strohl
M
,
Holy
CE
,
Hanick
AL
,
Bryson
PC
.
Prevalence of atopic disease in patients with eosinophilic esophagitis
.
Int Forum Allergy Rhinol
.
2017
;
7
(
8
):
757
62
.
44.
O’Shea
KM
,
Aceves
SS
,
Dellon
ES
,
Gupta
SK
,
Spergel
JM
,
Furuta
GT
, et al
.
Pathophysiology of eosinophilic esophagitis
.
Gastroenterology
.
2018
;
154
(
2
):
333
45
.
45.
Spergel
J
,
Aceves
SS
.
Allergic components of eosinophilic esophagitis
.
J Allergy Clin Immunol
.
2018
;
142
(
1
):
1
8
.
46.
Arias
Á
,
González-Cervera
J
,
Tenias
JM
,
Lucendo
AJ
.
Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis
.
Gastroenterology
.
2014
;
146
(
7
):
1639
48
.
47.
Underwood
B
,
Troutman
TD
,
Schwartz
JT
.
Breaking down the complex pathophysiology of eosinophilic esophagitis
.
Ann Allergy Asthma Immunol
.
2023
;
130
(
1
):
28
39
.
48.
Kliewer
KL
,
Gonsalves
N
,
Dellon
ES
,
Katzka
DA
,
Abonia
JP
,
Aceves
SS
, et al
.
One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial
.
Lancet Gastroenterol Hepatol
.
2023
;
8
(
5
):
408
21
.
49.
Guajardo
JR
,
Zegarra-Bustamante
MA
,
Brooks
EG
.
Does aeroallergen sensitization cause or contribute to eosinophilic esophagitis
.
Clin Rev Allergy Immunol
.
2018
;
55
(
1
):
65
9
.
50.
Iwanczak
B
,
Janczyk
W
,
Ryzko
J
,
Banaszkiewicz
A
,
Radzikowski
A
,
Jarocka-Cyrta
E
, et al
.
Eosinophilic esophagitis in children: frequency, clinical manifestations, endoscopic findings, and seasonal distribution
.
Adv Med Sci
.
2011
;
56
(
2
):
151
7
.
51.
Almansa
C
,
Krishna
M
,
Buchner
AM
,
Ghabril
MS
,
Talley
N
,
DeVault
KR
, et al
.
Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults
.
Am J Gastroenterol
.
2009
;
104
(
4
):
828
33
.
52.
Wang
FY
,
Gupta
SK
,
Fitzgerald
JF
.
Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children
.
J Clin Gastroenterol
.
2007
;
41
(
5
):
451
3
.
53.
Hurrell
JM
,
Genta
RM
,
Dellon
ES
.
Prevalence of esophageal eosinophilia varies by climate zone in the United States
.
Am J Gastroenterol
.
2012
;
107
(
5
):
698
706
.
54.
Ram
G
,
Lee
J
,
Ott
M
,
Brown-Whitehorn
TF
,
Cianferoni
A
,
Shuker
M
, et al
.
Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis
.
Ann Allergy Asthma Immunol
.
2015
;
115
(
3
):
224
8.e1
.
55.
Jensen
ET
,
Shah
ND
,
Hoffman
K
,
Sonnenberg
A
,
Genta
RM
,
Dellon
ES
.
Seasonal variation in detection of oesophageal eosinophilia and eosinophilic oesophagitis
.
Aliment Pharmacol Ther
.
2015
;
42
(
4
):
461
9
.
56.
Moawad
FJ
,
Veerappan
GR
,
Lake
JM
,
Maydonovitch
CL
,
Haymore
BR
,
Kosisky
SE
, et al
.
Correlation between eosinophilic oesophagitis and aeroallergens
.
Aliment Pharmacol Ther
.
2010
;
31
(
4
):
509
15
.
57.
Leslie
C
,
Mews
C
,
Charles
A
,
Ravikumara
M
.
Celiac disease and eosinophilic esophagitis: a true association
.
J Pediatr Gastroenterol Nutr
.
2010
;
50
(
4
):
397
9
.
58.
Ooi
CY
,
Day
AS
,
Jackson
R
,
Bohane
TD
,
Tobias
V
,
Lemberg
DA
.
Eosinophilic esophagitis in children with celiac disease
.
J Gastroenterol Hepatol
.
2008
;
23
(
7 Pt 1
):
1144
8
.
59.
Quaglietta
L
,
Coccorullo
P
,
Miele
E
,
Pascarella
F
,
Troncone
R
,
Staiano
A
.
Eosinophilic oesophagitis and coeliac disease: is there an association
.
Aliment Pharmacol Ther
.
2007
;
26
(
3
):
487
93
.
60.
Thompson
JS
,
Lebwohl
B
,
Reilly
NR
,
Talley
NJ
,
Bhagat
G
,
Green
PHR
.
Increased incidence of eosinophilic esophagitis in children and adults with celiac disease
.
J Clin Gastroenterol
.
2012
;
46
(
1
):
e6
11
.
61.
Abraham
JR
,
Persad
R
,
Turner
JM
,
Huynh
HQ
.
Gluten-free diet does not appear to induce endoscopic remission of eosinophilic esophagitis in children with coexistent celiac disease
.
Can J Gastroenterol
.
2012
;
26
(
8
):
521
4
.
62.
Hiramoto
B
,
Zalewski
A
,
Gregory
D
,
Yang
G-Y
,
Ho
N
,
Gonsalves
N
, et al
.
Low prevalence of extraesophageal gastrointestinal pathology in patients with eosinophilic esophagitis
.
Dig Dis Sci
.
2022
;
67
(
7
):
3080
8
.
63.
Ludvigsson
JF
,
Aro
P
,
Walker
MM
,
Vieth
M
,
Agréus
L
,
Talley
NJ
, et al
.
Celiac disease, eosinophilic esophagitis and gastroesophageal reflux disease, an adult population-based study
.
Scand J Gastroenterol
.
2013
;
48
(
7
):
808
14
.
64.
Lucendo
AJ
,
Arias
Á
,
Tenias
JM
.
Systematic review: the association between eosinophilic oesophagitis and coeliac disease
.
Aliment Pharmacol Ther
.
2014
;
40
(
5
):
422
34
.
65.
Lucendo
AJ
,
Arias
Á
,
Pérez-Martínez
I
,
López-Vázquez
A
,
Ontañón-Rodríguez
J
,
González-Castillo
S
, et al
.
Adult patients with eosinophilic esophagitis do not show an increased frequency of the HLA-DQ2/DQ8 genotypes predisposing to celiac disease
.
Dig Dis Sci
.
2011
;
56
(
4
):
1107
11
.
66.
Johnson
JB
,
Boynton
KK
,
Peterson
KA
.
Co-occurrence of eosinophilic esophagitis and potential/probable celiac disease in an adult cohort: a possible association with implications for clinical practice
.
Dis Esophagus
.
2016
;
29
(
8
):
977
82
.
67.
Ayaki
M
,
Manabe
N
,
Fujita
M
,
Katsumata
R
,
Nakamura
J
,
Kamada
T
, et al
.
Prevalence of autoimmune disease in patients with eosinophilic esophagitis: a cross-sectional study of three hospitals in Japan
.
Intern Med
.
2021
;
60
(
22
):
3525
31
.
68.
Peterson
K
,
Firszt
R
,
Fang
J
,
Wong
J
,
Smith
KR
,
Brady
KA
.
Risk of autoimmunity in EoE and families: a population-based cohort study
.
Am J Gastroenterol
.
2016
;
111
(
7
):
926
32
.
69.
Malik
A
,
Liu
BD
,
Zhu
L
,
Kaelber
D
,
Song
G
.
A comprehensive global population-based analysis on the coexistence of eosinophilic esophagitis and inflammatory bowel disease
.
Dig Dis Sci
.
2024
;
69
(
3
):
892
900
.