Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis

Abstract

SummaryBackgroundPrior work suggests eosinophilic oesophagitis (EoE) is rare in those aged over 65 years. However, elderly patients with EoE experience a substantial diagnostic delay from symptom onset to diagnosis.AimsTo assess if age predicted whether oesophageal biopsies were obtained in patients with EoE symptoms, what clinical features predict EoE in the elderly, and if EoE phenotype differs between elderly and non‐elderly patients.MethodsWe conducted a retrospective cohort study utilising the University of North Carolina (UNC) electronic medical record, EoE clinicopathologic database and UNC endoscopy software from July 2008 to April 2021. A sample of 193 elderly and non‐elderly patients with dysphagia, chest pain and/or heartburn were assembled. Patients with EoE were newly diagnosed per contemporaneous guidelines. Patient demographics, clinical characteristics and procedural data were extracted. Summary statistics, bivariate and multivariate analyses were performed.ResultsOf 193 patients, we included 91 elderly (47%) and 102 non‐elderly (53%). Age independently predicted the odds of biopsies (adjusted odds ratio (aOR): 0.44 elderly vs. non‐elderly; 95% CI: 0.21–0.92). Endoscopic features of EoE, but not symptoms, were more common in elderly than non‐EoE elderly patients. Elderly patients with EoE differed from non‐elderly only by time to diagnosis (aOR per year of symptoms preceding diagnosis: 1.08, 95% CI: 1.04–1.11).ConclusionsElderly patients with EoE have <50% the odds of oesophageal biopsies. There were no significant differences between elderly and non‐elderly EoE patients, although endoscopic features helped discriminate the two groups. Our findings suggest that older age represents a barrier to EoE diagnosis.

Editorial: Eosinophilic oesophagitis coming of age—Increasing frequency and wider age range—Authors' reply

“…The authors' declarations of personal and financial interests are unchanged from those in the original article 2 …”

“…We thank Dr. Attwood for his insightful commentary 1 on our study 2 and for contextualising our results within the overall epidemiologic paradigm of eosinophilic oesophagitis (EoE). As Dr. Attwood described, EoE was historically considered a disease of young white men with comorbid atopic conditions 3 .…”

Editorial: Eosinophilic oesophagitis coming of age—Increasing frequency and wider age range

“…Often the procedure is delayed while medical treatments and protocols for milk intolerance take precedence. Kiran et al 7 have highlighted how advancing age can also act as a barrier to prompt diagnosis. The odds of having oesophageal biopsies in patients aged ≥65 years were <50% of those of younger patients despite endoscopic signs of EoE being more common in the elderly.…”