Eosinophilic Esophagitis in the Middle East: Insight From a Comprehensive Systematic Review

Sep 29, 2026

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Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus defined by esophageal dysfunction and dense eosinophilic infiltration (≥15 eosinophils per HPF) after excluding other causes. While global incidence is increasing, Middle East evidence is limited and fragmented. This systematic review synthesizes data from Middle Eastern populations, covering clinical presentation, allergic comorbidities, diagnostic practice, histology and endoscopy, and management approaches through July 2025.

LanguageEnglish

CategoryHealthcare

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Abstract

Background

Methods

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Introduction

JGH Open SYSTEMATIC REVIEW OPEN ACCESS Eosinophilic Esophagitis in the Middle East: Insight From a Comprehensive Systematic Review Nouran Alwisi1 | Sidra Abdul Moqeeth1 | Muneera Al-Mohannadi1,2 1College of Medicine, QU Health, Qatar University, Doha, Qatar | 2Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar Correspondence: Muneera Al-Mohannadi ([malmohannadi@hamad.qa](malmohannadi@hamad.qa)) Received: 7 August 2025 | Revised: 15 October 2025 | Accepted: 21 October 2025 Funding: This work was supported by Hamad Medical Corporation. Keywords: eosinophilic esophagitis | epidemiology | Middle East | systematic review ABSTRACT Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus, defined by esophageal dysfunction and dense eosinophilic infiltration (≥15 eosinophils per HPF) in biopsies, after exclusion of other causes. While its global incidence is rising, data from the Middle East remain limited and fragmented. This systematic review aims to comprehensively synthesize available evidence on EoE in Middle Eastern populations, focusing on clinical presentations, allergic comorbidities, diagnostic practices, histological and endoscopic findings, and management strategies. Methods: A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted through July 2025. Studies were included if they reported original data on EoE patients from Middle Eastern countries, describing demographics, clinical features, diagnosis, or management. Data extraction and quality appraisal were performed independently by two reviewers, using Joanna Briggs Institute (JBI) tools. Results: Sixty seven studies comprising 2870 EoE patients from 11 Middle Eastern countries were included. A pronounced male predominance was observed (male-to-female ratios: approximately 2:1 in adults, 2.5:1 in children) . Clinical presentations mirrored global patterns, with dysphagia and food impaction as predominant symptoms. Allergic comorbidities were commonly reported. Diagnostic criteria were consistent, but underdiagnosis and misclassification were noted. Histological and endoscopic findings were broadly in line with international data, though mucosal remodeling and strictures were frequently observed, suggesting diagnostic delays. Management approaches included the use of PPIs, corticosteroids, dietary elimination, and, in selected cases, dupilumab. Conclusions: Middle Eastern EoE patients display clinical features, comorbidities, and management patterns like those seen globally. Unique regional aspects such as dietary exposures, allergic profiles, and diagnostic challenges highlight the need for improved clinician awareness and standardized diagnostic protocols. 1 | Introduction Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder characterized clinically by symptoms of esophageal dysfunction, including dysphagia, food impaction, vomiting, and abdominal pain, and histologically by significant eosinophilic infiltration (≥ 15 eosinophils per high-power field [HPF]) in esophageal biopsies, after excluding other causes such as gastroesophageal reflux disease (GERD) or eosinophilic gastroenteritis [1]. Since its characterization in the early 1990s, EoE This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. JGH Open, 2026; 10:e70305 1 of 9 [https://doi.org/10.1002/jgh3.70305](https://doi.org/10.1002/jgh3.70305) has evolved from a rare clinical curiosity into an increasingly recognized disorder of esophageal inflammatory diseases in high-inc

FAQs

What defines eosinophilic esophagitis (EoE) in this review?

EoE is defined by esophageal dysfunction plus dense eosinophilic infiltration (≥15 eosinophils per HPF) on biopsy after excluding other causes such as GERD or eosinophilic gastroenteritis.

How was the evidence gathered for Middle East EoE?

A systematic search of PubMed, Scopus, Embase, and Web of Science was performed through July 2025, including studies reporting original EoE patient data from Middle Eastern countries. Data extraction and quality appraisal used Joanna Briggs Institute (JBI) tools with independent reviewers.

What did the review report about clinical presentation and management?

Across included studies, dysphagia and food impaction were predominant symptoms, and allergic comorbidities were commonly reported. Management approaches included PPIs, corticosteroids, dietary elimination, and dupilumab in selected cases.

Sep 29, 2026

Uploaded by Stanley