Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: The population-based Kalixanda study

Jukka Ronkainen ^1*, Nicholas J Talley ², Pertti Aro ¹, Tom Storskrubb ¹, Sven-Erik Johansson ¹, Tore Lind ³, Elisabeth Bolling-Sternevald ³, Michael Vieth ⁴, Manfred Stolte ⁴, Marjorie M Walker ⁵ and Lars Agréus ¹

¹ Centre for Family and Community Medicine, Karolinska Institutet, Sweden
² Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, United States
³ Astrazeneca R&D Mölndal, Sweden
⁴ Klinikum Bayreuth, Germany
⁵ Department of Histopathology, Faculty of Medicine, Imperial College, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: jukka.ronkainen{at}fimnet.fi.

Accepted 5 October 2006

Abstract

Background: Eosinophilic oesophagitis (EO) may be increasing but the prevalence in the general population remains unknown. Our aim was to assess this and the presence of eosinophils in the distal oesophageal epithelium in the community.

Methods: Oesophagogastroduodenoscopy was performed in a random sample (n=1000) of the adult Swedish population (mean age 54 years, 49% men). Oesophageal biopsies were obtained from 2 cm above, and at the Z-line. Any eosinophil infiltration of the epithelium was defined as 'eosinophils present'. Definite EO was defined as 20, probable as 15-19 and possible as 5-14 eosinophils/high power field (HPF, at magnification x40) in oesophageal biopsies.

Results: Eosinophils were present in 48 subjects (4.8%, 95% CI 3.5-6.1%, mean age 54 yrs, 63% men), in 54% without troublesome reflux symptoms. Definite EO was present in 4 (0.4% 95% CI 0.01-0.8%, mean age 51 yrs, 75% men) and probable in 7 subjects (0.7%, 95% CI 0.2-1.2%, mean age 58 yrs, 43% men). Erosive oesophagitis (OR=2.99, 95% CI 1.58-5.66) and absence of dyspepsia (OR=0.23, 95% CI 0.07-0.75) and H. pylori infection (OR=0.41, 95% CI 0.19-0.92) were independent predictors for 'eosinophils present'. Definite EO was associated with dysphagia (2/66 vs. 2/ 926, p=0.025) and probable EO with narrowing in the oesophageal lumen (2/15 vs. 5/978, p=0.005).

Conclusions: Oesophageal eosinophils were present in nearly 5% of the general population; approximately 1% had definite or probable EO. Oesophageal eosinophils may be a manifestation of reflux disease in adults but the condition is as likely to be asymptomatic and go unrecognised. (Word count 250)

Keywords: Eosinophilic oesophagitis, Epidemiology, GORD, Population-based

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