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Variation in Prevalence, Diagnostic Criteria, and Initial Management Options for Eosinophilic Gastrointestinal Diseases in the United States

Spergel, Jonathan M*; Book, Wendy M||; Mays, Elizabeth||; Song, Lihal; Shah, Samir S; Talley, Nicholas J; Bonis, Peter A#

Journal of Pediatric Gastroenterology & Nutrition: March 2011 - Volume 52 - Issue 3 - p 300–306
doi: 10.1097/MPG.0b013e3181eb5a9f
Original Articles: Gastroenterology

Objectives: Variation in the prevalence of eosinophilic gastrointestinal diseases in different geographical regions has not been extensively studied. The aim of the present study was to define the regional and national prevalence of eosinophilic gastrointestinal diseases, and differences in practice approaches.

Patients and Methods: We administered a survey electronically to members of the American College of Gastroenterology, the American Academy of Allergy, Asthma, and Immunology, and the North American Society Pediatric Gastroenterology, Hepatology, and Nutrition. Questions pertained to the number and proportion of patients seen with eosinophilic gastroenteritis or colitis and eosinophilic esophagitis (EoE), and methods used to diagnose and treat these conditions.

Results: A total of 1836 physicians responded from 10,874 requests (17% response). Extrapolating responses from our US sample, we estimated an overall prevalence of 52 and 28/100,000 for EoE and eosinophilic gastroenteritis or colitis. The patient burden of EoE is higher in urban (0.58) and suburban (0.44) compared with rural settings (0.36, P < 0.0065), observations consistent with other allergic disorders. There was also increased prevalence in northeast region when calculated by prevalence per 100,000. There was considerable variability in criteria and initial treatment options used to diagnose EoE. Only one-third of respondents reported using diagnostic criteria proposed in a 2007 consensus document. Seventy-one and 35% of respondents reported treating some patients with EoE with a food elimination or elemental diet, respectively.

Conclusions: EoE is diagnosed more often in northeastern states and urban areas. There is considerable variability in diagnostic criteria and initial treatment approach supporting the need for additional clinical trials and consensus development.

*Division of Allergy and Immunology, Department of Pediatrics, USA

Division of Infectious Diseases, Departments of Pediatrics and Biostatistics and Epidemiology, USA

HealthCare Analytic Unit of The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

||American Partnership for Eosinophilic Disorders, Houston, TX, USA

Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, USA

#Division of Gastroenterology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA.

Received 21 January, 2010

Accepted 11 May, 2010

Address correspondence and reprint requests to Jonathan Spergel, 3550 Market St, Suite 3050, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (e-mail: spergel@email.chop.edu).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Support for the work came from the American Partnership for Eosinophilic Disorders; K01-AI-73729 for SSS.

The data were originally presented in abstract form at the NASPGHAN annual meeting in October 2009.

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN