Eosinophilic Esophagitis in Patients with Chronic Reflux Symptoms: A Single-center Study from South India

Abstract Background and Objectives: Eosinophilic esophagitis (EoE) is increasingly recognized worldwide, but data from India remain limited. This study aimed to assess the hospital-based prevalence of EoE in patients with chronic reflux symptoms at our institution, a tertiary care center in South India, and identify potential predictors for the same. Materials and Methods: We enrolled adult patients with reflux symptoms persisting for 3 or more months from January 2022 to June 2022. Patients underwent symptom assessment using validated questionnaires, upper gastrointestinal endoscopy with systematic documentation using the EoE Endoscopic Reference Score (EREFS), and standardized esophageal biopsies. EoE was diagnosed based on ≥15 eosinophils per high-power field alongside esophageal dysfunction symptoms. Results: Among 197 included patients (62.4% male, mean age 41 ± 12 years), EoE was diagnosed in five patients, yielding a prevalence of 2.54% (95% confidence interval: 1.09–5.8). Atopic conditions were present in 28% of all patients. In EoE patients, endoscopic abnormalities were found in 40%. On multivariate analysis, elevated EREFS score (odds ratio [OR]: 2.65, P = 0.04) and presence of microabscesses (OR: 21.07, P = 0.02) independently predicted EoE. An EREFS score >0 showed high specificity (90%) but moderate sensitivity (40%) for diagnosing EoE. Conclusions: In our hospital-based patient population with chronic reflux complaints, EoE prevalence was 2.5%. Given this relatively low prevalence, routine esophageal biopsies may not be cost-effective. Instead, a targeted biopsy approach is recommended for patients with typical endoscopic findings or specific symptoms like dysphagia.