Eosinophilic Esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus, the muscular tube that carries food from the throat to the stomach. The condition is characterized by inflammation caused by a dense accumulation of eosinophils, a specific type of white blood cell, within the esophageal lining. This infiltration is typically triggered by an allergic response, often to certain foods or environmental allergens. While EoE was considered rare when first described in the early 1990s, its recognition has grown dramatically, leading to questions about its current frequency.
Current Statistics on EoE Frequency
The frequency of EoE is measured using two statistical concepts: prevalence (total existing cases) and incidence (new cases diagnosed over a specific period). Globally, the estimated pooled incidence of EoE is approximately 5.31 new cases per 100,000 people per year.
The global pooled prevalence is estimated to be around 40 cases per 100,000 inhabitants. In the United States, recent estimates suggest a higher prevalence, ranging from approximately 40 to 90 cases per 100,000 persons, translating to about 1 in 700 people in the U.S. population.
The frequency of EoE diagnosis has seen a substantial increase over time. Between 1976 and 2001, the pooled prevalence was estimated at 8.18 cases per 100,000 inhabitants. This figure surged to an estimated 74.42 cases per 100,000 inhabitants between 2017 and 2022, showing that EoE has transformed into a common gastrointestinal disorder.
Demographic Groups Most Affected
Certain demographic groups show a clear predisposition to EoE. The most striking difference is seen in gender, with a strong male predominance. Studies consistently show that males are diagnosed with EoE three to four times more often than females.
The disease affects both children and adults, often following a bimodal age pattern. Symptoms differ between the two groups. In adults, the condition often presents as difficulty swallowing (dysphagia) or food impaction. Children may present with less specific symptoms, such as feeding difficulties, vomiting, or abdominal pain.
There is a strong association between EoE and a history of atopic diseases. People with EoE frequently have other allergic conditions, such as asthma, allergic rhinitis (hay fever), or eczema. This link suggests that EoE is part of the “atopic march,” a natural progression of allergic disorders that begin early in life.
Factors Contributing to Rising Case Reports
The rapid increase in EoE diagnoses raises the question of whether the disease is truly becoming more common or if it is simply being identified more effectively. A significant factor is the improvement in physician awareness and the standardization of diagnostic criteria. Gastroenterologists and allergists are now more likely to consider EoE, leading to a lower threshold for performing an esophageal biopsy to confirm the diagnosis.
In the past, EoE was often misdiagnosed as gastroesophageal reflux disease (GERD), contributing to underreporting. As diagnostic techniques, such as endoscopy with biopsy, have become routine, cases previously attributed to reflux are now correctly identified as EoE. This improved diagnostic sophistication accounts for a portion of the observed rise in prevalence.
However, the rate of increase in EoE incidence seems to surpass what can be explained by better detection alone, suggesting a true increase in the disease’s occurrence. This true rise is thought to be linked to changes in environmental and lifestyle factors. Hypotheses center on early-life exposures, such as antibiotic use, cesarean delivery, and changes in the gut microbiome, which may disrupt immune system development. These factors align with the hygiene hypothesis, suggesting that reduced exposure to microbes in early life may increase the risk of allergic diseases, including EoE.