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. 2021 Jul;9(6):688-698.
doi: 10.1002/ueg2.12092. Epub 2021 Jun 12.

A diagnostic delay of 10 years in the DanEoE cohort calls for focus on education - a population-based cross-sectional study of incidence, diagnostic process and complications of eosinophilic oesophagitis in the North Denmark Region

Dorte Melgaard  1   2 , Signe Westmark  1 , Peter Thaysen Laurberg  3 , Anne Lund Krarup  1   3   2   4
Affiliations

A diagnostic delay of 10 years in the DanEoE cohort calls for focus on education - a population-based cross-sectional study of incidence, diagnostic process and complications of eosinophilic oesophagitis in the North Denmark Region

Dorte Melgaard et al. United European Gastroenterol J. 2021 Jul.

Abstract

Background: In the North Denmark Region with a population of 580,000 the awareness of eosinophilic oesophagitis (EoE) increased after 2011 due to a regional biopsy guideline. However, very little was known of the incidence, diagnostic process, or complications of EoE in Denmark.

Objective: The objectives of the study were to establish a cohort of EoE patients and describe the incidence, diagnostic process, and complications of EoE.

Methods: Patient files and histology reports for the 308 DanEoE cohort of patients with eosinophilia in the oesophagus in 2007-2017 identified by the histopathology registry were analyzed.

Results: The incidence of EoE in the North Denmark Region increased to 5.5-8.7/100,000 after 2011, where the regional biopsy guideline was implemented. The diagnostic delay was 10 (12) years for the EoE population. There was an insufficient number of biopsies sampled in 40 % of the patients. At the diagnostic endoscopy, the macroscopic appearance of the oesophagus was often described as normal (24%), and infrequently having one or more macroscopic signs of EoE (43%). Food bolus obstruction was observed in 38%, and strictures in 7.5% of EoE patients. In 22.2% of EoE patient's treatment was not initiated at debut.

Conclusions: The EoE incidence was documented. The diagnostic process was analyzed and showed an unmet need for education among referring physicians and endoscopists: A diagnostic delay of a decade, infrequently noted macroscopic EoE changes and lack of treatment at the debut in one fifth. Strictures in the DanEoE cohort were rare whereas food bolus obstruction was frequent.

Keywords: cohortstudies; complications; diagnostic delay; eosinophilia; eosinophilic esophagitis; esophagus; gastroesophageal reflux; incidence; population; registry; retrospective studies; stricture.

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Conflict of interest statement

The authors declares that there are no conflicts of interest.

The authors confirm that the ethical policies of the journal, as noted on the journal's author guidelines page, have been adhered to. The Regional Ethics Committee evaluated the project as not needing ethical approval within Danish law.

Figures

FIGURE 1
FIGURE 1
Incidence/eosinophilic oesophagitis (EoE) and gastro‐oesophageal reflux disease (GORD) with eosinophilia in the North Denmark Region. Figure 1a shows incidence for EoE patients in total and sub divided into ± comorbid GORD (pure EoE and EoE + GORD resp.). Figure 1b shows the incidence for GORD patients with oesophageal eosinophilia who did not have the EoE phenotype
FIGURE 2
FIGURE 2
Data suggesting a lack/knowledge/EoE among endoscopists and referring doctors with regards to EoE. The diagnostic lag is shown in Figure 2a for subgroups/EoE and GORD patients with eosinophilia. Figure 2b shows adherence to the regional biopsy guideline/sampling eight or more biopsies in all patients with dysphagia. Figure 2c shows the percentage/patients having a macroscopic esophagus description showing any EoE sign (white dots, furrows, edema, rings or, strictures) at the index endoscopy. Figure 2d shows how many patients did not receive treatment
FIGURE 3
FIGURE 3
Percentage/patients having complications with oesophageal eosinophilia. Figure 3a Food bolus obstruction, and Figure 3b strictures in need/dilation
See this image and copyright information in PMC

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