Original articles—alimentary tract
Epidemiology of Eosinophilic Esophagitis Over Three Decades in Olmsted County, Minnesota

https://doi.org/10.1016/j.cgh.2009.06.023Get rights and content

Background & Aims

Data on secular trends and outcomes of eosinophilic esophagitis (EE) are scarce. We performed a population-based study to assess the epidemiology and outcomes of EE in Olmsted County, Minnesota, over the last 3 decades.

Methods

All cases of EE diagnosed between 1976 and 2005 were identified using the Rochester Epidemiology Project resources. Esophageal biopsies with any evidence of esophagitis and/or eosinophilic infiltration were reviewed by a single pathologist. Clinical course (treatment, response, and recurrence) was defined using information collected from medical records and prospectively via a telephone questionnaire. Incidence rates per 100,000 person years were directly adjusted for age and sex to the US 2000 population structure.

Results

A total of 78 patients with EE were identified. The incidence of EE increased significantly over the last 3 of the 5-year intervals (from 0.35 [95% confidence interval (CI)], 0–0.87] per 100,000 person-years during 1991–1995 to 9.45 [95% CI, 7.13–11.77] per 100,000 person-years during 2001–2005). The prevalence of EE was 55.0 (95% CI, 42.7–67.2) per 100,000 persons as of January 1, 2006, in Olmsted County, Minnesota. EE was diagnosed more frequently in late summer/fall. The clinical course of patients with EE was characterized by recurrent symptoms (observed in 41% of patients).

Conclusions

The prevalence and incidence of EE is higher than previously reported. The incidence of clinically diagnosed EE increased significantly over the last 3 decades, in parallel with endoscopy volume. Seasonal incidence was greatest in late summer and fall. EE also appears to be a recurrent relapsing disease in a substantial proportion of patients.

Section snippets

Methods

This study was approved by the Mayo Clinic and Olmsted Medical Center Institutional Review Boards. This was a retrospective cohort study.

Case Identification

Figure 1 describes the process of identification of 78 patients with EE. Twenty-three of 78 (29%) of patients with EE were children (patients less than 18 years old at diagnosis).

Validation of Case Identification

Review of the random sample of 100 subjects with a diagnosis of “esophageal ring” who had undergone endoscopy identified 2 subjects with esophagitis and/or eosinophils mentioned in the pathology reports. These cases had already been reviewed by the pathologist as described above (and confirmed not to meet inclusion

Discussion

In this population-based study from the United States, we report secular trends in the epidemiology of eosinophilic esophagitis over the last 3 decades using robust case identification techniques as well a single histology standard. We observed a higher incidence of EE than that reported by previous studies. We found that the incidence of documented EE appears to have increased significantly over the last 3 decades. This increase has however paralleled the increase in endoscopy volume over the

Acknowledgments

The authors thank Judy Peterson for assistance in the data collection and preparation of the manuscript.

References (37)

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Conflict of interest These authors disclose the following: Dr Talley has received research support from Glaxo, Dynogen, and Tioga and has been a consultant to Astra Zeneca, Eisai, and Novartis. Dr Alexander has received research funding from Glaxo and Merck. The remaining authors disclose no conflicts.

Funding Supported in part by Glaxo SmithKline and the National Institutes of Health (U01DK065713-02). This study was also made possible by the Rochester Epidemiology Project (grant R01-AR30582 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases).

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