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RISING INCIDENCE OF EOSINOPHILIC ESOPHAGITIS IN THE CALGARY HEALTH REGION: A POPULATION-BASED STUDY
CI Williams, M Dupre, GG Kaplan, CN Andrews, EA Shaffer, PL Beck
Division of Gastroenterology, University of Calgary, Calgary, Alberta
BACKGROUND: Eosinophilic esophagitis (EE) appears to be an increasingly recognized cause of dysphagia and food impaction. Despite several reported case series, limited information is available on its true frequency.
AIM: The aim of the study was to characterize the incidence of EE in a well-defined population.
METHODS: A population-based cohort study was conducted between 2002 and 2006. All biopsy proven cases of EE in the Calgary Health Region (population 1.2million) were identified from a centralized pathology database. Demographic and endoscopic information was obtained through review of patient charts and a city-wide endoscopic database. Histopathological definition required finding characteristic features including >20 eos/hpf. Statistical analysis used a Poisson distribution with 95% confidence intervals. Ovid search identified the number of EE publications per year from years 2001 to 2006.
RESULTS: 186 cases of eosinophilic esophagitis were identified during the study period: 143in adults, 43 in children. The mean (median) ages in the adult vs. pediatric groups were 39.3 (38) vs. 11.8 (9) respectively with a range of 1 to 83years. Only two cases were identified in 2002; none in 2003. The annual incidence of EE increased from 1.83 (1.13-2.79) in 2004, 4.27 (3.17-5.63) in 2005 to 7.2 (5.76-8.89) in 2006 per 100,000 person-years, respectively. The incidence rates per upper endoscopy procedures also increased annually from 2004 to 2006 (mean with confidence intervals): from 2.16 (1.34-3.31), 5.20 (3.86-6.85) to 8.35 (6.68-10.31) per 1000 procedures, respectively. The relative percentage of adult cases rose from 33% to 93% from 2004 to 2006. Meanwhile EE publications increased over six fold from 2001 to 2006.
CONCLUSION: This is the largest reported population-based cohort study of biopsy proven eosinophilic esophagitis. Our incidence rates, including adults and children, were higher than previously published. The concurrent increase in the volume of publications about EE suggests that this increased incidence is due to increased disease awareness.