Barrett's Esophagus in Eosinophilic Esophagitis in Swiss Eosinophilic Esophagitis Cohort Study (SEECS)

Introduction: There is a complex interrelationship between gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) potentially promoting the occurrence and modulating severity of each other reciprocally. Presence of Barrett's Esophagus (BE) is a defining factor for the diagnosis of GERD. While several studies investigated the potential impact of concomitant GERD on the presentation and course of EoE, little is known with regards to BE in EoE patients.Methods: We analyzed prospectively collected clinical, endoscopic and histological data from patients enrolled in the Swiss Eosinophilic Esophagitis Cohort Study (SEECS) regarding differences between EoE patients with (EoE/BE+) vs. without BE (EoE/BE-) and determined the prevalence of BE in EoE patients.Results: Amongst a total of 509 EoE patients included in our analysis, 24 (4.7%) had concomitant BE with a high male preponderance (EoE/BE+ 83.3% vs EoE/BE- 74.4%). While there were no differences in dysphagia, odynophagia was significantly (12.5 vs. 3.1%, p=0.047) more common in EoE/BE+ vs. EoE/BE-. General well-being at last follow-up was significantly lower in EoE/BE+. Endoscopically we observed an increased incidence of fixed rings in the proximal esophagus in EoE/BE+ (70.8% vs. 46.3% in EoE/BE-, p=0.019) and a higher fraction of patients with a severe fibrosis in the proximal histological specimen (8.7% vs. 1.6% in EoE/BE, p=0.017). Conclusion: Our study reveals that BE is twice as frequent in EoE patients compared to general population. Despite many similarities between EoE patients with and without Barrett's esophagus, the finding of a more pronounced remodeling in EoE patients with Barrett is noteworthy.