Eosinophilic esophagitis prevalence update: Rapidly increasing frequency and regional disparities in Australasian children in six capital cities

Abstract

Background and Aim: Eosinophilic esophagitis (EE) is an important cause of fussy eating habits, dysphagia, and failure to thrive among children. We have previously presented limited data and now present a comprehensive outline of clinical data with a view to better understanding and guiding resource allocation and treatment decisions in future. Methods: We performed a retrospective chart review and interrogation of electronic medical records and histopathology databases using ICD-9/10 codes and appropriate keywords. Data were collected for clinical encounters between January 2008 and 31 December 2015 in seven tertiary pediatric hospitals in Australia and New Zealand; specifically, in Adelaide, Auckland, Christchurch, Melbourne, Perth, and Sydney. Included were patients aged 0-18 years who had EE according to esophageal biopsy, with >15 eosinophils/high-power field (hpf). Age at diagnosis, date of diagnosis, sex, racial background, comorbid atopic conditions, and choice and success of initial treatment were recorded. Absolute number of cases per region or population served was estimated and compared over two time periods: 2008-2011 and 2012-2015. Results: The prevalence of EE increased significantly over time across all sites (P < 0.05) (Table 1). Hospitals servicing larger populations diagnosed more cases of EE. Interestingly, there were many more cases of EE recorded in Sydney than Melbourne, despite a similar overall population, although New South Wales per se is a more populous state. The mean age (about 8 years) and male : female predominance was similar across sites. Diagnosis of EE among non-Caucasian patients was rare, although diagnoses were made in local Indigenous populations in Australia and New Zealand. Comorbid atopic conditions were common, with asthma predominant. Corticosteroids were chosen as the initial treatment at most sites, and initial treatment was confirmed as successful in a minority of patients (<30%). Conclusion: This is the first large EE prevalence study in in the southern hemisphere. The rapidly increasing prevalence of EE recorded in our study mirrors previous data from the northern hemisphere. The difference in apparent prevalence in Sydney compared with Melbourne warrants detailed consideration. Failure to record or achieve remission with initial treatment, and variability in management across sites, suggests the need to implement local guidelines, and the marked increase in prevalence has relevance for future resource allocation.L6361719612021-10-12 <br />