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Prevalence of Eosinophilic Esophagitis in the U.S.

Summary and Comment |
February 14, 2014

Prevalence of Eosinophilic Esophagitis in the U.S.

  1. David A. Johnson, MD

A conservative estimate was 39.5 cases per 100,000, although accuracy is still limited.

  1. David A. Johnson, MD

Reported incidence and prevalence rates of eosinophilic esophagitis (EoE) are on the rise. EoE is now a global health problem reported in every continent except Africa. Although its prevalence is estimated at approximately 1 in 1000 people, EoE has not been consistently defined across studies.

To estimate the prevalence of EoE in the U.S., investigators retrospectively examined 35,575,388 patient records from U.S. healthcare plan claims data. The case definition of EoE was any instance of the ICD-9 code 530.13, which occurred in 16,405 patient records. This code was previously validated in claims data for diagnosis of EoE (specificity, >99%; sensitivity, 37%). The overall prevalence was estimated within the database and then standardized to the U.S. population by age and sex using 2010 census data. A priori sensitivity analyses with more restrictive coding definitions were performed to exclude other conditions that could contribute to esophageal eosinophilia.

The overall prevalence rate, standardized to the U.S. population, was 56.7/100,000, which translated to 152,152 cases. The prevalence was more than doubled in men compared with women. Prevalence peaked in the 35-to-39-year age range and decreased after age 45. Using a more restrictive case definition for EoE, the estimated prevalence rate was 39.5/100,000, which translated to 105,977 cases in the U.S.

Comment

Despite the high quality of this study, the analyses did not adjust for the covariate of proton-pump inhibitor (PPI)–responsive esophageal eosinophilia, which, by consensus guidelines, is a distinct entity from eosinophilic esophagitis but may not be distinguishable by clinical or endoscopic features prior to a PPI trial. Therefore, the true prevalence of EoE remains unknown, although clearly, based on ICD-9 codes, it is likely a widespread condition.

  • Disclosures for David A. Johnson, MD at time of publication Consultant / Advisory board Abbott; Centacor; CRH Medical; Medscape; Pfizer; Takeda Pharmaceuticals Speaker's bureau Takeda Pharmaceuticals Editorial boards ACG Universe; MedScape Gastroenterology

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