Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

INTRODUCTION:Differences in eosinophilic esophagitis (EoE) presentation and outcomes by ethnicity or race remain understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-White race have differences in presentation at diagnosis or response to topical corticosteroid...

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Published inThe American journal of gastroenterology Vol. 119; no. 2; pp. 262 - 269
Main Authors Ocampo, Adolfo A., Xue, Zeyun, Chang, Nicole C., Thakkar, Kisan P., Reddy, Sumana B., Greenberg, Sydney B., Lee, Christopher J., Ketchem, Corey J., Redd, Walker D., Eluri, Swathi, Reed, Craig C., Dellon, Evan S.
Format Journal Article
LanguageEnglish
Published Philadelphia, PA Wolters Kluwer 01.02.2024
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
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ISSN0002-9270
1572-0241
1572-0241
DOI10.14309/ajg.0000000000002532

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Summary:INTRODUCTION:Differences in eosinophilic esophagitis (EoE) presentation and outcomes by ethnicity or race remain understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-White race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment.METHODS:This retrospective cohort study included subjects of any age with a new diagnosis of EoE and documentation of ethnicity or race. For those who had treatment with tCS and follow-up endoscopy/biopsy, we assessed histologic response (<15 eosinophils/hpf), global symptom response, and endoscopic response. Hispanic EoE patients were compared with non-Hispanics at baseline and before and after treatment. The same analyses were repeated for White vs non-Whites.RESULTS:Of 1,026 EoE patients with ethnicity data, just 23 (2%) were Hispanic. Most clinical features at presentation were similar to non-Hispanic EoE patients but histologic response to tCS was numerically lower (38% vs 57%). Non-White EoE patients (13%) were younger at diagnosis and had less insurance, lower zip code-level income, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. Of 475 patients with race data treated with tCS, non-Whites had a significantly lower histologic response rate (41% vs 59%; P = 0.01), and odds of histologic response remained lower after controlling for potential confounders (adjusted odds ratio 0.40, 95% confidence intervals: 0.19-0.87).DISCUSSION:Few EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. The non-White EoE group was larger, and presentation was less dysphagia-specific. Non-White patients were also less than half as likely to respond to tCS.
Bibliography:Correspondence: Evan S. Dellon MD, MPH. E-mail: edellon@med.unc.edu.SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/D73
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Dellon: Project conception, study design, data collection, data analysis/interpretation, manuscript drafting, critical revision
Author contributions (all authors approved the final manuscript)
Xue, Chang, Thakkar, Reddy, Greenberg, Lee, Ketchem, Redd, Eluri, Reed: Data collection and interpretation, critical revision
Ocampo: Study design, data collection and interpretation, manuscript drafting, critical revision
ISSN:0002-9270
1572-0241
1572-0241
DOI:10.14309/ajg.0000000000002532