Rapid increase in the prevalence of eosinophilic esophagitis among Australasian children: A decade of experience from 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. Although the prevalence, clinical characteristics, and management of patients in Australasia have not been described previously, understanding the disease burden and possible regional disparities in prevalence and differences in management may improve future treatment. Methods: We performed a retrospective chart review and interrogation of electronic medical records and histopathology database using ICD-9/10 codes and appropriate keywords. Data were collected for clinical encounters between January 2008 and December 31, 2015, in six tertiary pediatric hospitals in Australia and New Zealand (Adelaide, Auckland, Christchurch, Melbourne, Perth, and Sydney). Included were patients aged 0- 18 years who had EE according to esophageal biopsy, with > 15 eosinophils per high-power field. 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) (Fig. 1). Hospitals servicing larger populations diagnosed more cases of EE (Table 1). The mean age (about 8 years) and male to female predominance was similar across sites. Diagnosis of EE among non-Caucasian patients was rare, although diagnoses were made in local Indigenous populations in both countries. Comorbid atopic conditions were common, with asthma predominant. Corticosteroids were chosen as the initial treatment at the majority of sites, and initial treatment was confirmed as successful in a minority of patients (< 30%). Conclusion: This is the first large EE prevalence study in the southern hemisphere. The rapidly increasing prevalence of EE recorded in our study mirrors previous data from the northern hemisphere. The 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. (Figure presented) (Table presented).L6294566262019-10-04 <br />