Incidence of eosinophilic esophagitis in the Netherlands continues to rise: 20‐year results from a nationwide pathology database

• Published in: Neurogastroenterology and motility 2018-01, Vol.30 (1), p.n/a
• Main Authors: Warners, M. J., Rooij, W., Rhijn, B. D., Verheij, J., Bruggink, A. H., Smout, A. J. P. M., Bredenoord, A. J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; allergy; Autoimmune diseases; Child; Children; Databases, Factual; Endoscopy; Eosinophilia; eosinophilic esophagitis; Eosinophilic Esophagitis - epidemiology; Eosinophilic Esophagitis - pathology; epidemiology; Esophageal diseases; Esophagitis; Esophagus; Female; Gastrointestinal diseases; Humans; Incidence; Leukocytes (eosinophilic); Male; Middle Aged; nationwide incidence; Netherlands - epidemiology; Pathology; Retrospective Studies; Seasonal variations; Sex differences; Young Adult
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/nmo.13165

Background The incidence of eosinophilic esophagitis (EoE) has increased rapidly. Most epidemiologic data were gathered in single‐center studies over a short timeframe, possibly explaining the heterogeneous incidences. Aim The aim of this study was to retrospectively estimate the Dutch nationwide incidence of EoE over the last 20 years. Methods The Dutch pathology registry (PALGA) was queried to identify pathology reports describing esophageal eosinophilia from 1996 to 2016. Cases were eligible if EoE was confirmed by the pathologist. Using the annual Dutch population data, the incidence of EoE was calculated. Key Results The search yielded 11 288 reports of which 5080 described esophageal eosinophilia. Eosinophilic esophagitis was diagnosed in 2161 patients, 1574 (73%) males and 365 (17%) children. The incidence increased from 0.01 (95% CI 0‐0.02) in 1996 to 2.07 (95% CI 2.05‐2.23) per 100 000 inhabitants in 2015. The incidence was higher in males than in females, 3.02 (95% CI 2.66‐3.41) vs 1.14 (95% CI 0.93‐1.38), odds ratio (OR) 2.66 (95% CI 2.10‐3.36) and higher in adults than in children, 2.23 (95% CI 1.99‐2.49) vs 1.46 (95% CI 1.09‐1.91), OR 1.78 (95% CI 1.32‐2.40). Incidence of EoE increased more than 200‐fold, whereas endoscopy rates only tripled, from 30 in 1996 to 105 per 100 000 inhabitants in 2015. We observed no seasonal variation. Conclusions and Inferences In the last decades, the Dutch EoE incidence has increased tremendously and still continues to rise. This expansion is only partially driven by increased endoscopy rates. This study demonstrates that in the last 20 years the nationwide incidence of EoE has increased more than 200 times and still continues to rise. In addition, the increasing incidence of EoE outpaces the increased Dutch endoscopy with biopsy rates. With the current incidence, EoE signifies a high burden of disease and considerable cost to the healthcare system.