Systematic Review With Meta-analysis

The Growing Incidence and Prevalence of Eosinophilic Oesophagitis in Children and Adults in Population-based Studies

Pilar Navarro; Ángel Arias; Laura Arias-González; Emilio J. Laserna-Mendieta; Miriam Ruiz-Ponce; Alfredo J. Lucendo

Disclosures

Aliment Pharmacol Ther. 2019;49(9):1116-1125. 

In This Article

Abstract and Introduction

Abstract

Background: The frequency of eosinophilic oesophagitis (EoE) occurrence is escalating. Current diagnostic criteria recently proposed for the disease, determine that previous estimates of incidence and prevalence are outdated.

Aim: To gauge the current incidence and prevalence of EoE by performing a systematic review of population-based studies.

Methods: Three electronic databases were searched from their inception dates to September 2018. A total of 2386 documents were screened; 29 studies reported on the prevalence and incidence of EoE in the general population.

Results: The pooled prevalence of EoE was 34.4 cases per 100 000 inhabitants (95% CI, 23.1-47.5), and was higher for adults (42.2; 95% CI, 31.1-55) than for children (34; 95% CI, 22.3-49.2). The pooled EoE incidence rates were 6.6/100 000 person-years (95% CI, 3-11.7) in children and 7.7/100 000 (95% CI, 1.8-17.8) in adults. No differences were found between North American and European studies using varied sources of data (insurance and administrative databases compared to hospital-bases case series). Subgroup analysis according to risk of bias did not change results significantly. A steady rise in EoE incidence and prevalence rates was observed over time, comparing studies conducted under subsequent definitions for EoE. No significant publication bias was found.

Conclusions: In a systematic review and meta-analysis, we found a sharp increase, higher than previous estimates, in the incidence and prevalence of EoE in population based studies. Results from studies carried out in developed countries show broad consistency and provide evidence of increasing pooled prevalence and incidence of EoE rates over time.

Introduction

Eosinophilic oesophagitis (EoE) is a food-related allergic-mediated condition that triggers an eosinophil-predominant inflammatory response in the oesophageal mucosa leading to oesophageal dysfunction. Dysphagia and food impaction are the most characteristic symptoms in adults, while gastroesophageal reflux disease (GORD)-with similar symptoms and feeding disturbances, predominates in children.[1,2] Despite being a relatively new condition, first described less than 4 decades ago,[3] the expansion of EoE in the last decade has been such that at present it is already described as a common disease in clinical practice.

Several studies have documented the increasing frequency of the disease, some analysing the weight of EoE in series of endoscopies or biopsies, and others trying to establish the epidemiology of the disease in well-defined populations, either by analysing geographically confined regions, or using institutional registry data and electronic medical records.[4] In 2016, a systematic review of these population-based studies summarised an incidence of 0.7-10.0 per 100 000 person-years and a prevalence range of 0.2-43.0 per 100 000 person-years, with an increasing trend over successive years.[5] The time at which each study was developed, differences in the threshold of eosinophil count defining EoE and in how patients with a response to proton pump inhibitors (PPIs) were considered, as well as regional variations, are the most relevant explanations for the broad range of incidence and prevalence provided by this systematic review. The recent consideration that patients who respond to PPIs are within the spectrum of the disease rather than considered a different entity,[1,6] along with new data available from 2018 that provides the highest frequency for the disease reported so far[7–9] (and not included in recent reviews[10]), makes the previously reported prevalence and incidence figures outdated.

After the recent publication of relevant population-based studies providing new data on the current frequency of EoE in patients of all ages, this research aims to conduct a systematic review of the literature in order to update incidence and prevalence rates of EoE in children and adults. Assessing temporal trends in different geographic areas is a secondary aim.

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