Rising incidence and prevalence of adult eosinophilic esophagitis in midwestern Spain (2007–2016)

Abstract

Objectives: Epidemiologic studies on eosinophilic esophagitis (EoE) are scarce and patient responders to proton pump inhibitor (PPI) therapy have usually been excluded. We aimed to evaluate population-based incidence rates, prevalence and trends in adult EoE over the past decade, including responders to PPI therapy. Methods: We conducted an analysis of a prospectively established case registry in the health area of Cáceres, located in midwestern Spain. From the first EoE case diagnosed in 2007, endoscopy and pathology reports up to December 2016 were manually reviewed. A baseline diagnosis of EoE was confirmed upon symptoms of esophageal dysfunction (dysphagia/food impaction) and esophageal eosinophilia 15 eos/HPF. All patients were re-evaluated on PPI therapy during follow-up. Results: A total of 137 patients were diagnosed with EoE during the study period, of whom 63 (46%) achieved clinicohistologic remission on PPI therapy. The prevalence of autoimmune disorders was low. Mean incidence rate was 8.09 new cases/100,000 inhabitants/year, increasing to 9.95 during the last lustrum and peaking in 2016 with 13.7. This trend coincided with late declining of esophageal biopsies rate. Overall prevalence in 2016 was 81.73 patients/100,000 inhabitants, with the highest prevalence in males between age 35 and 44 years (273 cases/100,000). No seasonal variation was observed in the diagnosis of EoE (53% during pollen season vs. 47%, p ¼ 0.4). Conclusions: In midwestern Spain, incidence (13.7 cases/100,000 inhabitants/year) and prevalence (81.73 patients/100,000 inhabitants) in 2016 have grown remarkably in just one decade, coming closer to those figures recently reported for Crohn's disease in Spain.

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

“…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 …”

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

“…24,25 In accordance with this theory, another previously published epidemiological study included EoE and PPI-REE patients in their incidence estimation. 12 In conclusion, to our knowledge this is the largest populationbased study estimating the incidence of EoE over a 20-year timeframe.…”

“…The Danish incidence increased from 0.13 per 100 000 inhabitants in 1997 to 2.61 per 100 000 inhabitants in 2012. European incidences that fell within the higher range of the spectrum were estimated in Switzerland (2.45 per 100 000 inhabitants) and Spain (13.7 per 100 000 inhabitants) . However, in both studies incidences were acquired in regional healthcare centers or estimated from a district with only 90 000 inhabitants.…”

“…However, recently published data indicates that PPI‐REE and EoE are indistinguishable and that PPIs should be a first‐line therapy for EoE instead of a diagnostic test to exclude PPI‐REE . In accordance with this theory, another previously published epidemiological study included EoE and PPI‐REE patients in their incidence estimation …”

“…European incidences that fell within the higher range of the spectrum were estimated in Switzerland (2.45 per 100 000 inhabitants) and Spain (13.7 per 100 000 inhabitants). 5,12 However, in both studies incidences were acquired in regional healthcare centers or estimated from a district with only 90 000 inhabitants. We believe that our nationwide incidence gives a more accurate indication of the EoE incidence in Western European countries.…”