Emerging incidence trends of eosinophilic esophagitis over 25 years: Results of a nationwide register-based pathology cohort

Abstract

Rationale: Eosinophilic esophagitis (EoE) has emerged from a case-reportable illness in the early 1990s to a distinct clinicopathological entity. Increasing worldwide incidences have been observed, although due to various study designs estimates are inconsistent.

Aim: To determine population-based annual incidence rates over a time period of 25 years.

Methods: A nationwide register-based pathology (PALGA) search was performed to identify reports describing esophageal eosinophilia between 1995 and 2019. EoE was identified if the diagnosis was confirmed by the pathologist. Crude incidence rates were estimated by the number of new EoE cases per year and matched with population data.

Results: Between 1995 and 2019, 7361 unique patients' reports mentioned esophageal eosinophilia, of these 4061 were classified as EoE (71% male, mean age 37.9 ± 18.4 years). In total, 639 (16%) children (<18 years) were diagnosed. The EoE incidence increased from 0.01 in 1995 (95% CI: 0.0 - 0.04) to 3.16 (95% CI: 2.90 - 3.44) per 100.000 inhabitants in 2019. EoE was significantly more prevalent in males (OR 2.48 | 95% CI: 2.32 - 2.65; vs. females p < 0.001) and adults (OR 1.42 | 95% CI: 1.31 - 1.55; vs. children p < 0.001). Highest incidences were observed in 2019, being 4.37 (95% CI: 3.94 - 4.84) vs. 1.97 (95% CI: 1.68 - 2.29) per 100.000 males and females, respectively (p < 0.001). No seasonal variation was observed.

Conclusion: Over the past quarter century, the annual rates of newly diagnosed EoE patients raised dramatically and this increase has not reached a deceleration yet.

Keywords: eosinophilic esophagitis; epidemiology; esophageal eosinophilia and allergy; incidence.

FIGURE 1

Flowchart of case identification. After the initial PALGA search, revisions, incorrect reports, and duplicates, as well as reports with absence of esophageal eosinophilia or presence of eosinophils in the gastrointestinal (GI) tract were excluded. A total of 7361 unique patients were eligible for review, of which 4061 cases were identified as eosinophilic esophagitis (EoE) in accordance with the conclusion of the pathologist

FIGURE 2

Distribution of age at diagnosis in male and female patients with eosinophilic esophagitis (EoE), presented in 10 years strata

FIGURE 3

Seasonal distribution of newly diagnosed eosinophilic esophagitis (EoE) patients between 1995 and 2019 in the Netherlands

FIGURE 4

Incidence rates of eosinophilic esophagitis (EoE) in males and females between 1995 and 2019 in the Netherlands

FIGURE 5

Incidence rates of eosinophilic esophagitis (EoE) in children and adults (18+ years) between 1995 and 2019 in the Netherlands

FIGURE 6

Distribution of year of diagnosis in male and female patients with eosinophilic esophagitis (EoE), presented in 5 years strata

FIGURE 7

New EoE cases per 100.000 inhabitants per year and the estimated number of yearly performed endoscopies with esophageal biopsy sampling per 100.000 inhabitants, between the years of 1995 and 2019. Logarithmic y‐axes were used to visualize outcomes of different orders of magnitude in one graph