Incidence and prevalence of eosinophilic oesophagitis across Europe: A systematic review and meta‐analysis

Abstract

BackgroundSeveral studies have reported large increases in the incidence of eosinophilic oesophagitis (EoE) in the last 20 years. We aimed to systematically review the incidence and prevalence of EoE, focused on all European countries.MethodsSystematic review and meta‐analysis up to 31 December 2022, based on PubMed, CINAHL and extensive hand searching of reference lists. Twenty‐five eligible studies were identified and included.ResultsFor both adults and children, the highest EoE incidence and prevalence have been reported from regional studies in Spain. EoE incidence for both adults and children was significantly lower (p < 0.001) in nationwide studies (meta‐analysis = 3.64 per 100,000 person‐years overall) compared with regional or centre‐based studies (7.16). EoE incidence and prevalence were significantly higher (p < 0.001) in adults than children. All studies that reported on longitudinal trends in EoE incidence showed increases over time, more markedly during more recent years. Larger increases in incidence tend to refer to regional rather than nationwide studies; from Spain, Switzerland and Denmark, both for paediatric and adult age groups. Increases in EoE incidence 100,000 person‐years were larger than for incidence per number of diagnostic endoscopies. The most frequently reported co‐morbidities in adults were rhinitis, followed by asthma, food allergy and gastroesophageal reflux disease, and in children, erosive oesophagitis, asthma, food allergy and rhinitis.ConclusionsThe incidence of EoE has increased in Europe over the last 30 years, exceeding increases in the volume of oesophago‐gastro‐duodenoscopies performed. The patchy and low incidence and prevalence of EoE generally in Europe and compared with North America, may reflect a lack of clinical awareness and research focus rather than a genuinely low incidence of EoE. A co‐ordinated Europe‐wide study that uses standardised methodology is urgently needed to provide a comprehensive picture of EoE incidence and prevalence across Europe.

Mononuclear cell composition and activation in blood and mucosal tissue of eosinophilic esophagitis

“…What was once considered a rare disease is now, due to its increasing incidence and prevalence, the most common cause of food impaction ( 2 , 3 ). Interestingly, a recent meta-analysis of EoE incidence and prevalence in Europe suggests discrepancies and underdiagnosis of EoE in Europe when compared to North America, where the clinical awareness and research focus on the disease is more pronounced ( 4 ).…”

Inflammatory bowel diseases and eosinophilic oesophagitis: Two overlapping disorders?

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Inflammatory bowel diseases and eosinophilic oesophagitis: Two overlapping disorders?Inflammatory bowel diseases (IBD) and eosinophilic oesophagitis (EoE) are immune-mediated disorders of the gastrointestinal (GI) tract with an increasing incidence worldwide. 1,2 Both diseases are characterised by a loss of tolerance towards luminal antigens favoured by microbiota disruption suggesting that they may share similar pathophysiology. 3,4 Associations between the two diseases have been suggested in previous studies, especially the risk of developing EoE in individuals with IBD.

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