A diagnostic delay of 10 years in the DanEoE cohort calls for focus on education ‐ a population‐based cross‐sectional study of incidence, diagnostic process and complications of eosinophilic oesophagitis in the North Denmark Region

Abstract

Background: In the North Denmark Region with a population of 580,000 the awareness of eosinophilic oesophagitis (EoE) increased after 2011 due to a regional biopsy guideline. However, very little was known of the incidence, diagnostic process, or complications of EoE in Denmark. Objective:The objectives of the study were to establish a cohort of EoE patients and describe the incidence, diagnostic process, and complications of EoE. Methods: Patient files and histology reports for the 308 DanEoE cohort of patients with eosinophilia in the oesophagus in 2007-2017 identified by the histopathology registry were analyzed. Results:The incidence of EoE in the North Denmark Region increased to 5.5-8.7/100,000 after 2011, where the regional biopsy guideline was implemented.The diagnostic delay was 10 (12) years for the EoE population. There was an insufficient number of biopsies sampled in 40 % of the patients. At the diagnostic endoscopy, the macroscopic appearance of the oesophagus was often described as normal (24%), and infrequently having one or more macroscopic signs of EoE (43%). Food bolus obstruction was observed in 38%, and strictures in 7.5% of EoE patients. In 22.2% of EoE patient's treatment was not initiated at debut. Conclusions:The EoE incidence was documented. The diagnostic process was analyzed and showed an unmet need for education among referring physicians and endoscopists: A diagnostic delay of a decade, infrequently noted macroscopic EoE changes and lack of treatment at the debut in one fifth.Strictures in the DanEoE cohort were rare whereas food bolus obstruction was frequent.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.

Effectiveness of PPI treatment and guideline adherence in 236 patients with eosinophilic oesophagitis—Results from the population‐based DanEoE cohort shows a low complication rate

“…Further classification of this subgroup can be found in a recently published study 17 . Barrett's oesophagus was defined as intestinal metaplasia in salmon‐coloured oesophageal mucosa 23 .…”

“…The regional guideline endorsed sampling of at least 8 biopsies in all patients with oesophageal dysphagia regardless of the macroscopic findings, and the incidence of EoE increased 50-fold in the first year after implementation of the guideline. 16,17 The DanEoE cohort was implemented to evaluate whether the diagnostic process and treatment of EoE patients were according to the guideline. The DanEoE cohort is a regional, population-and registry-based cohort of EoE patients diagnosed between 2007 and 2017, with follow-up to 31 December 2018.…”

An artificial intelligence algorithm is highly accurate for detecting endoscopic features of eosinophilic esophagitis

“…EoE is becoming increasingly important due to its rising incidence, but endoscopists may still have difficulty detecting and diagnosing EoE during routine EGD, leading to diagnostic delay 1 , 2 , 24 , 25 . The suspicion of EoE during routine EGD and based on the endoscopic image alone is challenging 7 , 8 , and the presence of EoE must be suspected either clinically or macroscopically to prompt taking esophageal biopsies.…”

Accurate and timely diagnosis of Eosinophilic Esophagitis improves over time in Europe. An analysis of the EoE CONNECT Registry

“…20,21 As endoscopic findings in EoE can be subtle and unspecific, 22 and almost absent in up to 25% of patients, 23 they may be overlooked and esophageal biopsies not routinely performed. 24,25 As a result, the diagnostic delay reported for EoE is unacceptably long [26][27][28][29] and increases the risk of finding fibrotic complications of the disease. 26,30,31 Since 2007, several international clinical practice guidelines, 1,[32][33][34] consensus documents 14,35 and technical reviews 36 have been released to provide a scientific framework from which to approach the management of patients with EoE.…”

“… 20 , 21 As endoscopic findings in EoE can be subtle and unspecific, 22 and almost absent in up to 25% of patients, 23 they may be overlooked and esophageal biopsies not routinely performed. 24 , 25 As a result, the diagnostic delay reported for EoE is unacceptably long 26 , 27 , 28 , 29 and increases the risk of finding fibrotic complications of the disease. 26 , 30 , 31 …”