Incidence of eosinophilic esophagitis in the Netherlands continues to rise: 20‐year results from a nationwide pathology database

Abstract

Background The incidence of eosinophilic esophagitis (EoE) has increased rapidly. Most epidemiologic data were gathered in single‐center studies over a short timeframe, possibly explaining the heterogeneous incidences. Aim The aim of this study was to retrospectively estimate the Dutch nationwide incidence of EoE over the last 20 years. Methods The Dutch pathology registry (PALGA) was queried to identify pathology reports describing esophageal eosinophilia from 1996 to 2016. Cases were eligible if EoE was confirmed by the pathologist. Using the annual Dutch population data, the incidence of EoE was calculated. Key Results The search yielded 11 288 reports of which 5080 described esophageal eosinophilia. Eosinophilic esophagitis was diagnosed in 2161 patients, 1574 (73%) males and 365 (17%) children. The incidence increased from 0.01 (95% CI 0‐0.02) in 1996 to 2.07 (95% CI 2.05‐2.23) per 100 000 inhabitants in 2015. The incidence was higher in males than in females, 3.02 (95% CI 2.66‐3.41) vs 1.14 (95% CI 0.93‐1.38), odds ratio (OR) 2.66 (95% CI 2.10‐3.36) and higher in adults than in children, 2.23 (95% CI 1.99‐2.49) vs 1.46 (95% CI 1.09‐1.91), OR 1.78 (95% CI 1.32‐2.40). Incidence of EoE increased more than 200‐fold, whereas endoscopy rates only tripled, from 30 in 1996 to 105 per 100 000 inhabitants in 2015. We observed no seasonal variation. Conclusions and Inferences In the last decades, the Dutch EoE incidence has increased tremendously and still continues to rise. This expansion is only partially driven by increased endoscopy rates.

Systematic review with meta‐analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population‐based studies

“…Only the most recently published papers included in our review had EoE diagnosed by the current evidence‐based criteria, according to which, a response to PPI does not preclude a diagnosis of EoE, contrary with previous consensus guidelines . However, multiple studies, both in the early literature and in that published after the proposal of the so called PPI‐REE in 2011, did not exclude response to PPIs as a diagnostic requirement for EoE. In any case, it is clear that the frequency of EoE has progressively increased over the years as the criteria for the disease have been updated, reflecting a change in the epidemiology of the disease beyond that of including patients who previously responded to PPIs within the epidemiological calculations.…”

“…Most of the studies of the prevalence of EoE were conducted in United States (US), Canada and Europe, but there were also studies from Western Australia, and South America . Key differences in prevalence rates depended on whether the study population included only children, only adults or individuals of all ages, as well as on the time the study was undertaken and the definition of prevalence such as a point (16 studies or a period (11 studies); and methodology used, such as hospital‐based case series (14 studies), administrative database (7 studies), or insurance database (8 studies) (Table S1). Further variation was related to the definition of EoE considered by the various authors, which differed significantly over the period with regard to the role of pH‐monitoring and consideration of PPIs in the diagnostic and therapeutic algorithm of the disease …”

“…Eighteen studies examined the incidence of EoE in the general population. These studies were conducted in North America (US, Canada) and Europe (The Netherlands, Denmark, Switzerland and Spain) and looked at different groups of the population (children or adults or all ages) and different time periods. The studies were pooled to give an overall incidence rate estimate of 4.4 (95% CI, 2.8‐6.4) new cases of EoE per 100 000 inhabitants/year at risk of EoE based on a random‐effects model ( I 2 = 99.9%; Table ; Figure A).…”

<p>Eosinophilic esophagitis incidence in New Zealand: high but not increasing</p>

“…A recent meta-analysis found a pooled incidence rate of 3.7 per 100,000 persons per year 4. Several studies also report increasing incidence rates of EoE 5–12. However, no epidemiological data exist regarding New Zealand rates of EoE.…”

Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis

“…1,2 Dramatic increases in incidence and prevalence of EoE have been documented during the last 2 decades. [3][4][5] EoE is currently the most common cause of esophageal dysphagia and food bolus impaction. 6 Long-standing eosinophilic inflammation leads to esophageal remodeling in EoE, resulting in fibrosis with stricture formation and functional damage.…”