S0415 Eosinophilic Esophagitis in the United States from 2009-2015: Cross-Sectional Analysis of Office Visits From the National Ambulatory Medical Care Survey

Abstract

INTRODUCTION: Histologically, Eosinophilic Esophagitis (EoE) is defined by an accumulation of eosinophils in the mucosal lining of the esophagus. Leading symptoms are dysphagia, chest pain, and heartburn. Most cases occur in younger, non-Hispanic white males and co-occurrence with asthma is frequent. The incidence of EoE has increased over the last twenty years, partly due to increased recognition. To date, data on EoE is mostly limited to regional demographic studies. Our aim was to conduct a cross-sectional study examining demographics, comorbidities, and medication use of EoE patients in the United States (US) from 2009-2015. METHODS: The CDC’s National Ambulatory Medical Care Survey (NAMCS) uses weighted sampling methods to generate cross-sectional data representative of ambulatory care visits in the US. Using ICD-9 codes, we identified patients with EoE for the period 2009-2015. For these patients, we used visit codes to identify the following: presence of GERD, dysphagia, and asthma. Drug codes were used to investigate PPI and topical steroid use. Weighting of encounters using SPSS were performed to provide population estimates. RESULTS: After weighting, the study group included 710,339 unique outpatient visits for EoE; 63.9% male, mean age 35.5 years. Using corresponding estimated census data for 2013, the year with the greatest number of EoE visits, 70.1/100,000 outpatient visits in the US were for EoE. Race/ethnicity: non-Hispanic white 79.1% (6% higher than general population for 2013); NHB 18.5%; Hispanic 1.7%. Mean BMI was 25.3 ± 5.2 with 23.4% of patients having a BMI >30. Overall, 21.0% of patients had concomitant asthma. Among presenting complaints for an office visit, there were 29.0% with GERD, 15.0% with dysphagia, and 19.8% with an “allergy disorder”. Most patients were on PPI therapy (55.4%) and 29.4% were on topical steroids. CONCLUSION: Our nationwide data confirms that EoE affects younger adults, males, and the non-Hispanic white race out of proportion to the general population. About 1 in 5 EoE patients have asthma which is roughly 3 times higher than the general population supporting the association. GERD was the presenting complaint for nearly twice as many visits compared to dysphagia, a unique finding compared to previous studies. Most patients were on a PPI and nearly one-third were on topical steroids. Additional large scale, unbiased, population-based studies are needed to provide epidemiologic clarity concerning EoE.