Male Patients With Eosinophilic Esophagitis Face Higher Complication Rates

Male patients with eosinophilic esophagitis (EoE) have a higher complication rate than female patients with EoE, according to a study published in JGH Open.1

EoE is a chronic immune system disease characterized by the buildup of eosinophils in the esophagus, often triggered by food reactions, allergens, or acid reflux2; this can inflame or injure the esophageal tissue, leading to difficulty swallowing or food impaction. Previous studies determined that EoE is 2 to 3 times more likely to present in men than women.1

However, limited studies explore the risk of esophageal complications among genders, which may indicate differences in disease severity. Therefore, the researchers conducted a retrospective analysis to assess the differences in complications between hospitalized men and women with new or previously diagnosed EoE; they also evaluated variables like demographics, age, comorbidities, and month of presentation among male and female patients.

Compared with female patients, male patients with eosinophilic esophagitis (EoE) have higher rates of complications, including esophageal obstruction, food impaction, and rupture. | Image Credit: Yurii Kibalnik - stock.adobe.com

They used the National Inpatient Sample (NIS) developed for the Healthcare Cost and Utilization Project (HCUP), a publicly available database that approximates a 20% sample of all US hospital discharges. It included variables like age, race, month of presentation, and mortality. More specifically, the researchers analyzed patients within the NIS who were 18 years or older and admitted between 2016 and 2020 with previously or newly diagnosed EoE.

The NIS contained demographic data on 21,755 total EoE cases, 52% (n = 11,260) of whom were men. Regarding race, 79% of all patients were White, with more men being White than women (80.4% vs 76.9%; OR, 1.232; 95% CI, 1.063-1.429; P = .006). Conversely, a lower percentage of male patients were Black than female patients (6.4% vs 9.3%; OR, 0.668; 95% CI, 0.529-0.843; P < .001).

The researchers found that men had higher rates of several EoE complications, like esophageal obstruction (17.1% vs 11.9%; OR, 1.529; 95% CI, 1.529-1.819; P < .001), food bolus (10.3% vs 3.9%; OR, 2.841; 95% CI, 2.186-3.693; P < .001), and esophageal rupture (4.9% vs 1.2%; OR, 4.098; 95% CI, 2.657-6.322; P < .001). They were also more likely to require esophageal stricture dilation (1.1% vs 0.4%; OR, 2.818; 95% CI, 1.205-6.591; P = .013) or esophageal laceration repair (0.6% vs <0.1%; OR, 12.193; 95% CI, 1.594-93.275; P = .002).

Similarly, in a Black population subgroup analysis, the researchers determined that men had higher rates of esophageal dilation (2.8% vs 0.0%; OR, 4.266; 95% CI, 1.376-13.231; P = .006) and esophageal obstruction (20.8% vs 18.0%; OR, 1.574; 95% CI, 1.026-2.415; P = .036) despite the higher number of women in the Black population.

Additionally, men had higher esophageal rupture rates than women in 5 months of the year: March (3.3% vs 0.3%), April (2.9% vs 0.9%), July (2.9% vs 0.5%), November (2.7% vs 0.3%), and December (2.8% vs 0.6%). The researchers also found esophageal impaction rates to be significantly higher in men for most of the year (January, March, April, May, June, July, October, November, and December; P < .05).

Regarding age, men had higher rates of EoE hospitalizations between the ages of 20 and 24 years (9.7% vs 6.5%; OR, 1.536; 95% CI, 1.226-1.925; P < .001). However, men had lower EoE hospitalizations between the ages of 70 and 89 years.

Similarly, men experienced esophageal impaction more often than women aged between 25 and 29 years. Conversely, women experienced a significantly higher number of esophageal impaction cases than men between the ages of 75 and 79 years (7.3% vs 1.7%; OR, 0.221; 95% CI, 0.061-0.806; P = .013).

Lastly, the researchers acknowledged their limitations, including only analyzing hospitalized patients presenting with EoE. Because of the study’s potential selection bias, their findings may not apply to all patients with EoE. However, the researchers used their findings to suggest areas for further research.

“Further studies assessing the pathophysiology and histologic manifestations are necessary to determine if males indeed have a more severe disease process that accounts for higher rates of diagnosis of EoE in males,” the authors concluded.

References

1. Patel H, Elmer J, Liaquat H. Exploring the impact of gender on the characteristics and complications of eosinophilic esophagitis. JGH Open. 2024;8(12):e70059. doi:10.1002/jgh3.70059
2. Eosinophilic esophagitis. Mayo Clinic. Accessed January 3, 2025. https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197