Health-Related Quality of Life and Costs Associated With Eosinophilic Esophagitis: A Systematic Review

Mukkada, Vincent A.; Falk, Gary W.; Eichinger, Christian; King, Denise; Todorova, L.; Shaheen, Nicholas J.

doi:10.1016/j.cgh.2017.06.036

Cited by 107 publications

(71 citation statements)

References 26 publications

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“…According to Australian census data (46), it would mean that the survey captured between 4 and 40% of the pediatric EoE population in Australia, depending on what would be considered as accurate prevalence data at the time. A 2018 systematic review and meta-analysis (47), which included 13 studies, focused on HRQoL in patients with EoE of all ages. The sample sizes ranged from n = 8 (Australia) (48) to n = 140 (USA) (49), emphasizing the large sample size of the study reported here.…”

Section: Discussionmentioning

confidence: 99%

“…Our study showed that nearly two-thirds of the children did not have a healthcare card and a third of the respondents did not have private health insurance to reduce out-of-pocket expenses. Further exploration of financial burden is needed as existing data indicate that EoE-related costs are striking and consistently higher than those of healthy consumers (10,47). The economic impact of poorly coordinated care encompassing the possible duplication of services as parents attempt to meet the healthcare needs of their family must be carefully considered.…”

Section: Discussionmentioning

confidence: 99%

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Health Service Use and Treatment Choices for Pediatric Eosinophilic Esophagitis: Findings From a Cross-Sectional Survey of Australian Carers

et al. 2020

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Objectives: The incidence and the prevalence of eosinophilic esophagitis (EoE) are increasing, and healthcare utilization among children with EoE is high. This study provides novel insights into the health services and the treatments, including complementary medicines (CMs), used by carers to manage their children's EoE as well as the carers' beliefs and attitudes toward these treatments. Methods: A national cross-sectional online survey was conducted in Australia between September 2018 and February 2019. The survey included questions about health service and treatment utilization, health insurance and government support, health-related quality of life of children with EoE and their carers, views and attitudes toward CM use, and perceived efficacy of treatment. Results: The survey was completed by 181 carers (96.6% of whom were mothers) of EoE children. Most children (91.2%, n = 165) had seen a medical doctor for their EoE, and almost half had consulted with a CM practitioner (40.3%, n = 73). Pharmaceuticals (n = 156, 86.2%) were the most commonly used treatment option, followed by dietary changes (n = 142, 78.5%), CM products (n = 109, 60.2%), and CM therapies (n = 42, 23.2%). Most children received care from numerous practitioners on multiple occasions, indicating a substantial financial and treatment-related burden. Conclusions: A variety of practitioners are involved in the care of children with EoE, and a high rate of CM use warrants further attention to ensure that appropriate treatment is provided. Carer involvement and guidance, combined with individual practitioner expertise, referrals, and collaboration between providers, is essential to successfully navigate this complex disease and provide adequate care for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health Service Use and Treatment Choices for Pediatric Eosinophilic Esophagitis: Findings From a Cross-Sectional Survey of Australian Carers

et al. 2020

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“…Over the past 20 years, eosinophilic esophagitis (EoE) has emerged as a significant cause of upper gastrointestinal (GI) morbidity, with significant quality of life implications for patients ( Straumann and Simon, 2005 ; Hruz et al, 2011 ; Cianferoni and Spergel, 2016 ; Cianferoni et al, 2015 ; Mukkada et al, 2017 ) and an estimated $1.4 billion annual healthcare cost ( Jensen et al, 2015 ). This disorder can affect both children and adults, with symptoms that vary by age, but typically include difficulty eating, failure to thrive, dysphagia and food impaction.…”

Section: Introductionmentioning

confidence: 99%

Noncanonical NF-κB signaling and the essential kinase NIK modulate crucial features associated with eosinophilic esophagitis pathogenesis

Eden

Rothschild

McDaniel

et al. 2017

Disease Models &Amp; Mechanisms

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Eosinophilic esophagitis (EoE) is an allergic disease of the esophagus driven by T cell and eosinophil responses to dietary allergens, resulting in chronic mucosal inflammation. Few spontaneous animal models of esophageal eosinophilia exist, with most studies relying on artificial sensitization procedures. NF-κB-inducing kinase (NIK; MAP3K14) is a key signaling molecule of the noncanonical NF-κB (NFKB1) pathway, an alternative signaling cascade producing chemokines involved in lymphoid stroma development and leukocyte trafficking. Nik−/− mice have been shown to develop a hypereosinophilic syndrome in peripheral blood and major filtering organs; however, the gastrointestinal mucosa of these mice has not been well characterized. We show that Nik−/− mice develop significant, localized eosinophilic esophagitis that mimics human EoE, including features such as severe eosinophil accumulation, degranulation, mucosal thickening, fibrosis and basal cell hyperplasia. The remainder of the GI tract, including the caudal stomach, small intestine and colon, in mice with active EoE are unaffected, also similar to human patients. Gene expression patterns in esophageal tissue of Nik−/− mice mimics human EoE, with thymic stromal lymphopoetin (TSLP) in particular also elevated at the protein level. In gene expression data sets from human biopsy specimens, we further show that many genes associated with noncanonical NF-κB signaling are significantly dysregulated in EoE patients, most notably a paradoxical upregulation of NIK itself with concurrent upregulation of powerful protein-level destabilizers of NIK. These findings suggest that Nik−/− mice could be useful as a spontaneous model of specific features of EoE and highlight a novel role for noncanonical NF-κB signaling in human patients.

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“…2 Patients with EoE experience dysphagia, food impaction, and disease anxiety, which significantly affect quality of life of patients and their families. 3 The diagnosis of EoE is established by clinical symptoms of esophageal dysfunction and esophageal eosinophilia 15 eosinophils per high-power field (eos/hpf). 4 Therefore, both initial diagnosis and histologic response to therapy can only be made through pathologic assessment of endoscopic biopsies.…”

mentioning

confidence: 99%

Noninvasive Diagnosis of Eosinophilic Esophagitis

Wright

Kita

2020

Mayo Clinic Proceedings

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Health-Related Quality of Life and Costs Associated With Eosinophilic Esophagitis: A Systematic Review

Abstract: EoE negatively impacts the HRQoL of patients and their families, and is a burden to the health care system. Although data are sparse, currently available treatments appear to improve HRQoL.

Cited by 107 publications

References 26 publications

Health Service Use and Treatment Choices for Pediatric Eosinophilic Esophagitis: Findings From a Cross-Sectional Survey of Australian Carers

Health Service Use and Treatment Choices for Pediatric Eosinophilic Esophagitis: Findings From a Cross-Sectional Survey of Australian Carers

Noncanonical NF-κB signaling and the essential kinase NIK modulate crucial features associated with eosinophilic esophagitis pathogenesis

Noninvasive Diagnosis of Eosinophilic Esophagitis

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