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

Abstract

Background:The frequency of eosinophilic oesophagitis (EoE) occurrence is escalating. Current diagnostic criteria recently proposed for the disease, determine that previous estimates of incidence and prevalence are outdated.Aim: To gauge the current incidence and prevalence of EoE by performing a systematic review of population-based studies.Methods: Three electronic databases were searched from their inception dates to September 2018. A total of 2386 documents were screened; 29 studies reported on the prevalence and incidence of EoE in the general population. Results:The pooled prevalence of EoE was 34.4 cases per 100 000 inhabitants (95% CI, 23.1-47.5), and was higher for adults (42.2; 95% CI, 31.1-55) than for children (34; 95% CI, 22.3-49.2). The pooled EoE incidence rates were 6.6/100 000 person-years (95% CI, 3-11.7) in children and 7.7/100 000 (95% CI, 1.8-17.8) in adults.No differences were found between North American and European studies using varied sources of data (insurance and administrative databases compared to hospital-bases case series). Subgroup analysis according to risk of bias did not change results significantly. A steady rise in EoE incidence and prevalence rates was observed over time, comparing studies conducted under subsequent definitions for EoE. No significant publication bias was found. Conclusions:In a systematic review and meta-analysis, we found a sharp increase, higher than previous estimates, in the incidence and prevalence of EoE in population based studies. Results from studies carried out in developed countries show broad consistency and provide evidence of increasing pooled prevalence and incidence of EoE rates over time.Additional supporting information will be found online in the Supporting Information section at the end of the article.How to cite this article: Navarro P, Arias Á, Arias-González L, Laserna-Mendieta EJ, Ruiz-Ponce M, Lucendo AJ. Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther.

Editorial: the evolving epidemiology of EoE—up, up, and away?

“…1 The calcineurin inhibitors (ciclosporin and tacrolimus) and purine antagonists (mycophenolate mofetil and mercaptopurine) have been enlisted as rescue drugs. [1][2][3] Rescue regimens have been empiric, untested in head-to-head clinical trials and ascribed outcomes that have been variably defined.…”

“…Mycophenolate mofetil (MMF) has emerged as the most actively reported rescue medication. 2,4 The retrospective, multicentre, observational study of Nicoll et al 5 provides much needed guidance in selecting those individuals who are likely to achieve an optimal outcome (as defined by the European and American liver societies 6,7 )…”

“…As in previous studies, MMF therapy was more frequently effective in patients intolerant of primary therapy than in those refractory to it (62% vs 38%). 2,5,9 The key question is why some patients can be rescued with MMF and others cannot. The Rescuing patients from their original medication is different than rescuing them from their disease.…”

The use of amino acid‐based nutritional feeds is effective in the dietary management of pediatric eosinophilic oesophagitis

“…Variation exists in the literature on the prevalence of pediatric EoE where it is reported, varying between 0.2 and 43 cases per 100 000 . A recent meta‐analysis of population‐based studies published pooled the prevalence of pediatric EoE across North America and Europe to estimate overall prevalence at 34.4/100 000 and overall incidence at 6.6/100 000 . An increasing trend over the past decade has been captured in several reports; a recent cohort study in Utah found 24 cases/100 000 .…”

“…12 A recent meta-analysis of population-based studies published pooled the prevalence of pediatric EoE across North America and Europe to estimate overall prevalence at 34.4/100 000 and overall incidence at 6.6/100 000. 13 An increasing trend over the past decade has been captured in several reports; a recent cohort study in Utah found 24 cases/100 000. 14 Together with this study from Utah, figures for the epidemiology of EoE in European children were simultaneously provided by Arias et al 15 where the incidence was reported as 10.6/ 100 000 in children.…”