Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States

Abstract

Objectives: Variation in the prevalence of eosinophilic gastrointestinal diseases in different geographical regions has not been extensively studied. The aim of the present study was to define the regional and national prevalence of eosinophilic gastrointestinal diseases, and differences in practice approaches.

Patients and methods: We administered a survey electronically to members of the American College of Gastroenterology, the American Academy of Allergy, Asthma, and Immunology, and the North American Society Pediatric Gastroenterology, Hepatology, and Nutrition. Questions pertained to the number and proportion of patients seen with eosinophilic gastroenteritis or colitis and eosinophilic esophagitis (EoE), and methods used to diagnose and treat these conditions.

Results: A total of 1836 physicians responded from 10,874 requests (17% response). Extrapolating responses from our US sample, we estimated an overall prevalence of 52 and 28/100,000 for EoE and eosinophilic gastroenteritis or colitis. The patient burden of EoE is higher in urban (0.58) and suburban (0.44) compared with rural settings (0.36, P < 0.0065), observations consistent with other allergic disorders. There was also increased prevalence in northeast region when calculated by prevalence per 100,000. There was considerable variability in criteria and initial treatment options used to diagnose EoE. Only one-third of respondents reported using diagnostic criteria proposed in a 2007 consensus document. Seventy-one and 35% of respondents reported treating some patients with EoE with a food elimination or elemental diet, respectively.

Conclusions: EoE is diagnosed more often in northeastern states and urban areas. There is considerable variability in diagnostic criteria and initial treatment approach supporting the need for additional clinical trials and consensus development.

FIGURE 1

A, Distribution of EoE in US regions. B, Distribution of EG-EC in the United States. Prevalence based on physician response corrected for the number of physician per state and state population. EG-EC = eosinophilic gastroenteritis or colitis; EoE = eosinophilic esophagitis.

FIGURE 2

Distribution of EoE in the United States. Prevalence based on physician response corrected for the number of physician per state and state population. States divided into 9 regions (A) or 4 regions (B) based on previous studies (12,13). EoE = eosinophilic esophagitis.

FIGURE 3

Distribution of EG-EC in the United States. Prevalence based on physician response corrected for the number of physicians per state and state population. States divided into 9 regions (A) or 4 regions (B) based on previous studies (22,23). EG-EC = eosinophilic gastroenteritis or colitis.