Low biopsy rates and proton pump inhibitor use limit the detection of eosinophilic esophagitis in Mexican patients with dysphagia.

INTRODUCTION

eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disorder increasingly recognized worldwide, but its prevalence in Hispanic populations, particularly in Mexico, remains poorly characterized. This study aimed to determine the biopsy rate and prevalence of EoE among patients undergoing elective endoscopy for esophageal dysphagia in a tertiary referral center in central Mexico.

METHODS

a cross-sectional, retrospective review was performed of adult patients who underwent esophagogastroduodenoscopy (EGD) for esophageal dysphagia between January 2017 and December 2022. Patients with prior surgery, non-esophageal dysphagia, or incomplete endoscopic/histologic data were excluded. Demographics, endoscopic findings, biopsy practices, and pathology results were collected, and all biopsies were re-reviewed by an expert gastrointestinal pathologist. Multivariable logistic regression was used to identify predictors of biopsy acquisition and of eosinophilic esophagitis diagnosis.

RESULTS

of 853 EGDs performed for dysphagia, 366 met inclusion criteria (mean age 55.8 years; 69.7 % women). Biopsies were obtained in 29.5 % (n = 108). Overall EoE prevalence was 2.7 % (95 % CI: 1.32-4.97 %) but increased to 9.3 % (95 % CI: 4.53-16.37 %) among those biopsied. The overall proton pump inhibitor (PPI) use at the time of endoscopy was recorded in 42.9 %. In the biopsy model, normal mucosa (OR 0.36, 95 % CI: 0.19-0.68) and achalasia (OR 0.16, 95 % CI: 0.04-0.69) were associated with decreased odds of biopsy, whereas EoE-suggestive findings increased biopsy likelihood (OR 11.9, 95 % CI: 1.38-103.1). In the diagnostic model, younger age (OR 0.95 per year, 95 % CI: 0.91-1.00), rings (OR 25.1, 95 % CI: 3.29-191.3), and edema (OR 14.5, 95 % CI: 1.38-151.8) were independent predictors of eosinophilic esophagitis.

CONCLUSION

in this Mexican dysphagia cohort, biopsy uptake was suboptimal and examinations frequently occurred under PPI therapy, likely contributing to under-detection. As one of the first large studies in an adult Hispanic population, our findings emphasize how local practices impact EoE detection. Implementing systematic biopsy protocols and enhancing clinician awareness may improve diagnostic yield in Mexico.