Original Article

CME Article: Epidemiology, Clinical Presentation, and Seasonal Variation in the Diagnosis of Children with Eosinophilic Esophagitis in Oklahoma

Authors: Kinjal Suryawala, MD, Sirish Palle, MD, Muhammad A. Altaf, MD


Objectives: Eosinophilic esophagitis (EoE) is characterized by upper gastrointestinal tract symptoms in association with esophageal mucosal biopsy specimens containing ≥15 intraepithelial eosinophils per high-power field. The etiology of EoE remains unclear, but an immunologic response to various foods and aeroallergens has been implicated. Seasonal variation has been reported in the diagnosis of EoE. The epidemiology and seasonal variation of EoE has never been studied in Oklahoma. The aim of this retrospective study was to determine epidemiology, clinical presentation, and seasonal variation of EoE in children seen from 2008 to 2015 at The Children’s Hospital at Oklahoma University Medical Center (OUMC).

Methods: This was a single-center study involving the medical records of children aged 0 to 18 years with a diagnosis of EoE at OUMC in the Department of Pediatric Gastroenterology from January 2008 to December 2015. All charts with “eosinophilic esophagitis” in the diagnostic search history were reviewed. A diagnosis of EoE was defined as presence of ≥15 eosinophils per high-power field in the esophageal mucosal biopsy. The data extracted from the medical records included demographics, previous proton pump inhibitor use prediagnosis, clinical presentation, blood and skin allergy testing, and month of diagnosis. Seasons were distributed as spring (March–May), summer (June–August), fall (September–November), and winter (December–February).

Results: Seventy-nine patients with a diagnosis of EoE were seen at OUMC between 2008 and 2015. One patient was excluded because of insufficient medical records. The average age (±standard deviation) at diagnosis was 7.5 (±4.92) years with an age range of 1 to 17 years. χ2 analysis showed a significant sex distribution, with 72% males and 27% females (P = 0.0001). The most common presenting symptoms were dysphagia (35%) and vomiting (28%). When patients were grouped seasonally using the χ2 test, there was an increase in the diagnosis of EoE cases during the spring months when compared with other seasons (P = 0.0006). Forty-five percent of patients were diagnosed in the spring, 22% in the fall, 19% in the summer, and 14% in the winter.

Conclusions: Our data demonstrate that there is a seasonal variation in the diagnosis of EoE, with more cases diagnosed in the spring months. These findings relate to the increase in aeroallergens and pollen distribution during the spring months in Oklahoma.
Posted in: Gastroenterology44 Esophageal Disease2

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Papadopoulou A, Koletzko S, Heuschkel R, et al. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 2014;58:107-118.
2. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med 2004;351:940-941.
3. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20.e6.
4. Moawad FJ, Veerappan GR, Lake JM, et al. Correlation between eosinophilic oesophagitis and aeroallergens. Aliment Pharmacol Ther 2010;31:509-515.
5. Rezende ER, Barros CP, Ynoue LH, et al. Clinical characteristics and sensitivity to food and inhalants among children with eosinophilic esophagitis. BMC Res Notes 2014;7:47.
6. Mishra A, Hogan SP, Brandt EB, et al. An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001;107:83-90.
7. Fogg MI, Ruchelli E, Spergel JM. Pollen and eosinophilic esophagitis. J Allergy Clin Immunol 2003;112:796-797.
8. 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;41:451-453.
9. Sorser SA, Barawi M, Hagglund K, et al. Eosinophilic esophagitis in children and adolescents: epidemiology, clinical presentation and seasonal variation. J Gastroenterol 2013;48:81-85.
10. Elitsur Y, Aswani R, Lund V, et al. Seasonal distribution and eosinophilic esophagitis: the experience in children living in rural communities. J Clin Gastroenterol 2013;47:287-288.
11. Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342-1363.
12. Prasad GA, Alexander JA, Schleck CD, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 2009;7:1055-1061.
13. Almansa C, Krishna M, Buchner AM, et al. Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults. Am J Gastroenterol 2009;104:828-833.
14. Iwanczak B, Janczyk W, Ryzko J, et al. Eosinophilic esophagitis in children: frequency, clinical manifestations, endoscopic findings, and seasonal distribution. Adv Med Sci 2011;56:151-157.
15. Ram G, Lee J, Ott M, et al. Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis. Ann Allergy Asthma Immunol 2015;115:224-228.e1.
16. Schlegel CR, Quintanilla NM, Olive AP, et al. Relationship of pediatric eosinophilic esophagitis diagnosis to pollen and mold counts. Ann Allergy Asthma Immunol 2014;113:321-322.