Eosinophilic Oesophagitis in Patients Presenting with Dysphagia: A Retrospective Study from a Single Tertiary Care Centre in Saudi Arabia

Background and Study Aims: Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in many Western countries, especially in young adults; however, the prevalence of EoE in Middle Eastern countries remains unknown. We aimed to estimate the prevalence of EoE in Saudi patients presenting with dysphagia. Additionally, we aimed to assess the practice pattern of physicians with respect to evaluating these patients.

Patients and Methods: We performed aretrospective review of all adolescent and adult patients who underwent upper gastrointestinal endoscopy for the assessment of dysphagia. Demographic data and endoscopic and histologic findings were reviewed. The primary outcome was the prevalence of biopsy proven EoE, defined as 15 or more eosinophils per high power field (≥15eos/hpf) in patients presenting with dysphagia. Secondary outcomes included the frequency of endoscopic features suggestive of EoE and the physician’s judgement about the need for oesophageal biopsies to diagnose EoE.

Results: A total of138 patients were identified and reviewed. The mean age was 50.7 years; 43.5% were males and 56.5% were female. Endoscopy revealed normal oesophageal mucosa in 52.9% of the patients. White plaques were reported in 4.3%, linear furrows in 2.9% and multiple rings (trachealization) in 2.2% of patients. Oesophageal biopsies were obtained from 20.3% of all patients to rule out EoE, this included 7.1% of those with normal appearance of the oesophageal mucosa. Only two patients (1.4%) with biopsy proven EoE were identified from this cohort; both were young adults.

Conclusions: Failure to perform oesophageal biopsies in patients presenting with dysphagia as per international guidelines could explainthe low prevalence of EoE observed in this population. Alternatively, the prevalence of EoE may be lower than expected in the Middle Eastern countries. Large prospective studies are necessary to accurately assess the prevalence of EoE in Middle Eastern countries.