S1070 Clinical Outcomes in Eosinophilic Esophagitis Patients With and Without Atopic Comorbidities: A Multicenter Retrospective Analysis

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by eosinophil-predominant inflammation of the esophagus. EoE frequently coexists with atopic conditions such as asthma, food allergies, atopic dermatitis, chronic sinusitis, and prurigo nodularis. However, the impact of individual and multiple atopic comorbidities on EoE-related clinical outcomes remains incompletely characterized. We aimed to compare clinical outcomes in EoE patients with versus without atopic comorbidities using real-world data. Methods: We performed a retrospective cohort analysis using the TriNetX database, a global federated health research network encompassing 69 healthcare organizations. Patients with EoE were categorized based on the presence or absence of comorbid atopic conditions. Outcomes included hospitalization, food impaction, endoscopy, dysphagia, chest pain, regurgitation, nausea/vomiting, and acid reflux. Inverse odds ratios (iORs) were calculated to reflect risk in the EoE + atopy group relative to EoE alone. Results: Across 7 comparisons, EoE patients with atopic comorbidities had greater odds of adverse outcomes than those with EoE alone. Asthma was linked to higher odds of hospitalization (1.736; P < 0.001), dysphagia (1.136), nausea/vomiting (1.376), chest pain (1.603), and reflux (1.439) (all P < 0.001). Food allergy was associated with increased dysphagia (1.131; P = 0.015), nausea/vomiting (1.139; P = 0.019), and reflux (1.142; P = 0.007), but reduced food impaction (0.700; P = 0.024). Atopic dermatitis was tied to less food impaction (0.273; P < 0.001) and more chest pain (1.570; P = 0.014). Chronic sinusitis was linked to several symptoms, including hospitalization (1.391; P < 0.001). Prurigo showed no significant differences. Multiple atopic conditions increased odds of food impaction (2.123; P = 0.046), chest pain (2.375; P < 0.001), and hospitalization (1.359; P = 0.039). Conclusion: EoE patients with atopic comorbidities—particularly asthma, food allergy, and chronic sinusitis—face significantly higher odds of hospitalization, gastrointestinal symptoms, and food impaction. Risk is further elevated with multiple atopic conditions, such as asthma combined with food allergy or atopic dermatitis. These findings suggest a more severe EoE phenotype, warranting more aggressive or tailored management. Future strategies should integrate atopic profiles into risk stratification to enable personalized care and closer monitoring.