Su1146

The Utility of Obtaining Biopsies for Eosinophilic Esophagitis (EoE) inPatients With Dysphagia Based on Endoscopic FindingsVu Le, Shoaib Ahmad, Sindhu Kaitha, Ralph Guild, Minh Phan, Kenneth J. Vega

Background: Current guidelines indicate obtaining tissue to evaluate for eosinophilic esophag-itis (EoE) as an option in patients with dysphagia who receive upper endoscopy evaluationwithout obvious cause for their complaint. However, the utility of this practice is unclear.The primary aim of the study was to determine the diagnostic yield of pathologic evaluationfor EoE in patients with normal and abnormal findings on upper gastrointestinal endoscopyat the University of Oklahoma Health Sciences Center (OUHSC). Methods: All cases witha primary indication of dysphagia from January 2006 to November 2011 were retrospectivelyidentified using the OUHSC electronic endoscopy database. Patients who had endoscopicbiopsies for pathologic evaluation of EoE during their procedure were included for analysis.The pathologic reports and endoscopic findings were independently reviewed by differentphysicians who were not aware of the other results, then correlated by a third investigatorto determine diagnostic yield rates for patients with and without endoscopic findings suggest-ive of EoE. Results: A total of 3,448 upper gastrointestinal endoscopies were performed atOUHSC during the study period. 547 procedures from 527 patients, age 18 to 90, metentry criteria and were analyzed. Review of these exams revealed 284/547 (52%) with anormal upper gastrointestinal endoscopy, 85/547 (16%) with features suggestive of EoE(furrowing or longitudinal rings), 73/547 (13%) with esophagitis, 45/547 (8%) with loweresophageal strictures or Schatzki ring, and 60/547 (11%) with other findings. Pathologicreview indicated 303/547 (55%) with esophagitis, 207/547 (38%) with normal mucosa, and37/547 (7%) with EoE. Among the 37 patients diagnosed with EoE, endoscopy revealed 23(62%) with features of EoE, 7 (19%) with normal exam, and 7 (19%) with esophagealstenosis or esophagitis. The overall pathologic yield of EoE to endoscopic findings was 23/85 (27%) with features suggestive of EoE, 7/284 (2%) with normal exam, and 7/178 (4%)with all other findings. Conclusions: Endoscopic biopsies for pathologic evaluation of EoEoften yield positive results in patients with endoscopic features suggestive of EoE. However,the yield of biopsies in those without endoscopic features suggestive of EoE is very low andis unlikely to alter patient management with increased cost.

Su1147

Prevalence of Eosinophilic Esophagitis in African Americans and HispanicsPresenting With Dysphagia: A Single Center Retrospective AnalysisAnand Gupta, Yahuza Siba, Saritha Gorantla, Menachem Schechter, Elena Tsai, Joan A.Culpepper-Morgan

Objective: Increasing prevalence of Eosinophilic Esophagitis (EoE) has been reported in thelast few years. It is typically diagnosed in adults in the third to fourth decades and has beenmore commonly reported in Caucasian males. There is lack of contemporaneous data onthe prevalence of EoE in African Americans (AA) and Africans. As our hospital populationpredominantly comprises of African Americans and Hispanics, the study was undertakento assess the current prevalence of EoE in this patient cohort. Methods: Since the mostcommon presentation of EoE is dysphagia, all patients evaluated for dysphagia at HarlemHospital from October 2009 to October 2011 were studied. The cohort was analyzed fora) demographic variables: age, sex and racial distribution b) endoscopic appearances & c)esophageal biopsy results. EOE was defined as the presence of >15 eosinophils/high powerfield. Results: A total of 71 patients were identified who were evaluated for primary complaintsof dysphagia (n=71). All underwent an endoscopic exam. Male to female ratio was 1:1.7.The average age in this cohort was 54 years. Of 71 patients, 53 were AA and 18 wereHispanic. Out of a total of 71 patients, 69 had esophageal biopsies (mid and distal), resultsof which are depicted in Table 1. There was only a single case of EoE diagnosed in a Hispanicpatient (prevalence of 1.4%). Conclusions: It appears from this retrospective analysis thatthe prevalence of EoE is low in African Americans. It has been reported in previous studiesthat approximately 15% of patients being evaluated for dysphagia with endoscopy are foundto have eosinophilic esophagitis (Prasad et al, 2007). Further large studies need to beundertaken in our population with standardized biospsy protocols evaluating patients withdysphagia and symptoms of refractory reflux to fully assess the prevalence of this disease.

S-437 AGA Abstracts

Table 1

Su1148

Changing Epidemiology of Food Bolus Impaction: Is Eosinophilic Esophagitisto Blame?Venkatswamy Mahesh, Nam Q. Nguyen

INTRODUCTION: The epidemiology of acute food bolus impaction (FBI) in adults remainsunclear. The incidence of eosinophilic esophagitis (EE) is increasing and is a well-knowncause for FBI. Currently, there are no data on the epidemiological changes in FBI and itsrelationship to EE. AIM: To evaluate the changes in prevalence and etiology of FBI.METHODS: Details relating to all patients who presented with FBI to the Department ofGastroenterology at the Royal Adelaide Hospital from 1996 to 2010 were reviewed from aprospective database. The periods were divided into 1996-2000, 2001-2005 and 2006-2010. Detailed endoscopic and histological findings were examined for patients who pre-sented between these periods. RESULTS: Over 15 years, 248 patients presented with FBI(74% male). The prevalence of FBI increased overtime (1996-2000: n=30; 2001-2005: n=80; 2006-2010: n=137). Whilst there was no change in gender, the age of presentation wassignificantly younger in 2006-2010 (56.2 ± 1.6 yrs) than that from 2001-2005 (61.6 ± 1.9yrs, P=0.03) and 1996-2000 (62.8 ± 3.3 yrs, P<0.01). The predominant causes for FBIbetween 1996 and 2000 related to benign strictures and complications of reflux disease(64%), and no patient had EE. The diagnosis of EE was suspected during endoscopy in10% of patients in 2001-2005 and 35% of patients in 2006-2010 (P<0.01). Esophagealbiopsies were taken significantly more frequently in patients who presented with FBI between2006-2010 (75%) as compared to those in 2001-2005 (47%, P<0.01) and 1996-2000 (12%,P<0.001). Histologically proven EE was found in 6.2% of patients in 2001-2005 and 23%of patients in 2006-2010 (P<0.01). There were no significant changes in other etiologiesovertime (benign strictures, reflux disease, malignancy, or post-surgical strictures). Endos-copic findings of “normal” esophageal structure or mucosa reduced overtime occurred in23% in 1996-2000, 17% in 2001-2005 and 14% in 2006-2010. CONCLUSIONS: Theincreased prevalence of food bolus impaction overtime is associated with an increasedprevalence of eosinophilic esophagitis. Whilst this may be related, increasing awarenessabout eosinophilic esophagitis and lower threshold for performing esophageal biopsy arealso likely to contribute.

Su1149

Lack of Seasonal Variation in the Incidence of Eosinophilic EsophagitisNicholas W. Frederickson, Ye-Jin Lee, Matthew K. Redd, Jorge Go, Jessica Valestin, RonSchey

BACKGROUND: Eosinophilic esophagitis (EoE) has been associated with allergic disordersas well as aeroallergens. The current literature has shown a possible association betweenseasonal variation, mainly in the spring, and the incidence of EoE. However, this data wasbased on small population studies. AIM: The primary aim of this study was to determineif there is a seasonal variation associated with the diagnosis of EoE in our population.METHODS: Esophageal biopsies were obtained from a cohort of patients who presented

AG

AA

bst

ract

s