Background & Aims: Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States. Methods: We estimated health care use and spending based on the most currently available administrative claims from commercial and Medicare Supplemental plans, data from the GI Quality Improvement Consortium Registry, and national databases. Results: In 2015, annual health care expenditures for gastrointestinal diseases totaled $135.9 billion. Hepatitis ($23.3 billion), esophageal disorders ($18.1 billion), biliary tract disease ($10.3 billion), abdominal pain ($10.2 billion), and inflammatory bowel disease ($7.2 billion) were the most expensive. Yearly, there were more than 54.4 million ambulatory visits with a primary diagnosis for a GI disease, 3.0 million hospital admissions, and 540,500 all-cause 30-day readmissions. There were 266,600 new cases of GI cancers diagnosed and 144,300 cancer deaths. Each year, there were 97,700 deaths from non-malignant GI diseases. An estimated 11.0 million colonoscopies, 6.1 million upper endoscopies, 313,000 flexible sigmoidoscopies, 178,400 upper endoscopic ultrasound examinations, and 169,500 endoscopic retrograde cholangiopancreatography procedures were performed annually. Among average-risk persons ages 50–75 years who underwent colonoscopy, 34.6% had 1 or more adenomatous polyps, 4.7% had 1 or more advanced adenomatous polyps, and 5.7% had 1 or more serrated polyps removed. Conclusions: GI diseases contribute substantially to health care use in the United States. Total expenditures for GI diseases are $135.9 billion dollars annually—greater than for other common diseases. Expenditures are likely to continue increasing.

Background & Aims Gastrointestinal (GI), liver, and pancreatic diseases are a source of substantial morbidity, mortality, and cost in the United States (US). Quantification and statistical analyses of the burden of these diseases are important for researchers, clinicians, policy makers, and public health professionals. We gathered data from national databases to estimate the burden and cost of GI and liver disease in the US. Methods We collected statistics on healthcare utilization in the ambulatory and inpatient setting along with data on cancers and mortality from 2007 through 2012. We included trends in utilization and charges. The most recent data were obtained from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the National Cancer Institute. Results There were 7 million diagnoses of gastroesophageal reflux and almost 4 million diagnoses of hemorrhoids in the ambulatory setting in a year. Functional and motility disorders resulted in nearly 1 million emergency department visits in 2012; most of these visits were for constipation. GI hemorrhage was the most common diagnosis leading to hospitalization, with more than 500,000 discharges in 2012 at a cost of nearly $5 billion dollars. Hospitalizations and associated charges for inflammatory bowel disease, Clostridium difficile infection, and chronic liver disease have increased over the last 20 years. In 2011, there were more than 1 million people in the US living with colorectal cancer. The leading GI cause of death was colorectal cancer, followed by pancreatic and hepatobiliary neoplasms. Conclusions GI and liver diseases are a source of substantial burden and cost in the US.

Background & Aims Eosinophilic esophagitis (EoE) has become a major cause of upper gastrointestinal morbidity in children and adults. However, there are few data on the nationwide prevalence of EoE. We aimed to estimate the prevalence of EoE in the United States (US). Methods We collected health insurance claims from a large database that represented the US commercially insured population. We analyzed data from 2008 through 2011, identifying cases of EoE using a previously validated definition, and calculated a period prevalence using data from 2009 through 2011. EoE was defined as any instance of the ICD-9 code 530.13. We calculated the prevalence of the code in the database and standardized the estimate to the US population. Results Of 35,575,388 individuals in this database, 16,405 had at least 1 code for EoE. The mean age was 33.5 y, 65% were male, 55.8% had dysphagia, and 52.8% had a diagnostic code for at least 1 allergic condition. Among 11,569,217 individuals with continuous insurance coverage between mid-2009 and mid-2011, 6513 had at least one code for EoE. When standardized to the US population, the estimated period prevalence of EoE was 56.7/100,000 persons, translating to approximately 152,152 cases in the US. Prevalence peaked in men 35–39 y old, with a rate of 114.6/100,000 persons. Conclusions Despite its relatively recent description, EoE is frequently diagnosed in the US, with an estimated prevalence of 56.7/100,000 persons. This estimate depends on the accuracy of the ICD-9 code, but could be an underestimate, given that knowledge of the code and recognition of EoE are increasing.

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Objectives Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the U.S.. Methods We used the IMS Health LifeLink™, PharMetrics Plus™Claims Database, data representative of a U.S. national commercially-insured population containing medical and pharmaceutical claims for >75million individuals. We restricted our sample to patients age 0–64 with continuous enrollment between 7/1/2009–6/30/2011. We identified cases of eosinophilic gastritis, gastroenteritis, and colitis as defined by ≥1 instance of the ICD-9 codes 535.70, 558.41, and 558.42, respectively. We calculated the prevalence of the codes in the database and then standardized the estimates to the U.S. population by age and sex. Results The standardized estimated prevalences of eosinophilic gastritis, gastroenteritis, and colitis were 6.3/100,000, 8.4/100,000, and 3.3/100,000, respectively. The prevalence of eosinophilic gastroenteritis was highest among children age < 5 years, whereas eosinophilic gastritis was more prevalent among older age groups. We observed no age differences for eosinophilic colitis. Among affected patients there was a high proportion of co-existing allergic conditions, 38.5% for eosinophilic gastritis, 45.6% for gastroenteritis, and 41.8% for colitis. Concomitant allergic disease was most commonly identified in pediatric patients. Conclusions The prevalence of non-EoE EGIDs remains rare in the U.S., with less than 50,000 total patients affected. There appears to be a female predominance, as well as a high co-occurrence of atopic comorbidities.

A number of early life exposures may be associated with the development of EoE. These are potentially modifiable risk factors that if confirmed would have implications for improved understanding of EoE pathogenesis and disease prevention.

Objectives Eosinophilic esophagitis (EoE) has rapidly become a major cause of upper GI morbidity, but health care costs related to EoE have not been described. This study aimed to estimate EoE-related health care costs and utilization in the United States. Methods We performed a study of health care utilization of EoE cases compared to age- and sex-matched controls using administrative claims data, representative of the commercially insured population in the U.S. Cases of EoE were identified using a previously validated definition. We assessed inpatient, outpatient, emergency department, outpatient prescription, and endoscopy-related costs for patients with EoE, and estimated total costs related to EoE extrapolated to the U.S. population. Results We identified 8,135 cases of EoE and 32,540 controls. The median total annual cost per EoE case was $3,304 compared to $1,001 for controls (p<0.001). For EoE, median costs included $2,508/year for outpatient visits, $157 for endoscopies, and $325 for pharmacy claims, compared to $699, $0, and $76 for controls (p<0.001 for all). The overall median costs associated with EoE were $2,302/year/patient. Total costs in the U.S. ranged from $503 million to $1.36 billion/year, depending on the prevalence estimate, with costs attributable to EoE ranging from $350-$947 million/year. Conclusions Patients with EoE have an estimated annual health care cost of as much as $1.4 billion in the U.S. This represents a remarkable burden of disease for an entity that was essentially unknown two decades ago. These cost data can be used by policy makers to guide resource allocation.

Early-life factors, including maternal fever, preterm labor, cesarean delivery, and antibiotic or acid suppressant use in infancy, were associated with risk of pediatric EoE; having a pet in the home was protective. These results add to growing evidence that implicate early-life exposures in EoE pathogenesis.