Background: Eosinophilic Esophagitis (EE) is increasingly recognized among adults who present with either persistent heartburn or dysphagia, and has been associated in animal models with inhaled allergens. Many patients participating in the World Trade Center (WTC) rescue effort have increased exposure to aeroallergens. In our experience, in this group of patients, the prevalence of EE is higher than those patients with similar symptoms who do not have a similar exposure history. The aim of this study is to describe our center's experience, and to highlight relationships between EE and exposure in affected workers. Methods: Retrospective chart review of 45 patients, referred for GI evaluation for refractory heartburn between January 2007 and October 2008 from the New Jersey WTC monitoring program, was performed. Results: Most of the patients were male with an average age of 49 (95% CI 47.16-51.82) and a BMI of 27.77 (95% CI 28.61-30.94). 20 patients were on inhaled steroids and 3 were on oral prednisone. Of the 45 patients, 27 underwent EGD, 25 had endoscopic abnormalities of which 17 had significant esophageal findings on biopsy summarized as below (table 1). Only 4 patients had GERD before 9/11, 3 of whom were previously on PPIs. Of the 41 cases of new-onset GERD, 11 had complaints of dysphagia; 2 of these patients subsequently had documented EE. 3 cases of biopsy-proven EE were identified among the 45 referred rescue workers, yielding a prevalence of 6.67%. In our cohort all three patients developed GERD symptoms after participating in the relief efforts. Conclusions: The prevalence of EE in our study population appears to be 13-fold higher than the prevalence seen in a recent study of 74,162 general GI referrals, with a majority having heartburn symptoms. In our study a majority of patients (62.96%) undergoing EGD had significant esophageal findings. Exposure to aeroallergens such as in the WTC incident may be associated with increased prevalence of EE and endoscopic/pathologic abnormalities. In patients with appropriate symptoms and exposure history, this data suggests that EGD with biopsies should be considered. More detailed research, with multi-center collaboration across the 6 WTC monitoring program sites including geographic comparison, is warranted to confirm the results of this pilot study.
WTC; World Trade Center; Rescue workers; Gastrointestinal system disorders; Allergens; GERD; Gastroesophageal reflux disease; Cohort studies
Clifford S. Mitchell, MS, MD, MPH, Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Room 321, Baltimore, MD 21201
Issue of Publication
University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School, Piscataway
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