Letter: increasing incidence and prevalence of eosinophilic oesophagitis – author's reply

Abstract

We thank Dr Attwood for the interest in our recent paper,1, 2 and appreciate his thoughts about the importance for practitioners to be aware of eosinophilic oesophagitis (EoE). We do not have a definitive explanation for the relatively low rate of asthma in the EoE subjects in the Denmark health registries, and agree that the prevalence of asthma and other atopic disorders is typically reported to be higher in patients with EoE than we found in this study.3 However, because our asthma definition used selected ICD-10 codes (J45.0, J45.1, J45.8 and J45.9, as noted in Table S2) and not medical record validation of this condition, it is possible that not all cases of asthma were identified. We agree with Dr Attwood that chronic use of systemic steroids should be avoided in EoE, and recent guidelines highlight that while these are potentially effective in the short term, these agents should be reserved for patients who require rapid improvement in symptoms.4 In our study, while it is correct that 29% of adults with EoE received systemic steroids at some point during the study time frame, we did not examine the specific indication for their use, or the length of the course prescribed. While these medications could have been used for EoE, they also could have been used for any other indication. Further studies would be required to fully examine the extent to which systemic steroids are being used for EoE. The author's declarations of personal and financial interests are unchanged from those in the original article.2