Disease burden, diagnosis pathways and treatment patterns in patients with eosinophilic esophagitis: a real-world study.

Despite a rising prevalence of eosinophilic esophagitis (EoE), real-world data on current management challenges remain limited. To evaluate demographic and clinical characteristics, treatment patterns, and health outcomes in patients with EoE. Physicians from Canada, France, Germany, Spain, and the UK retrospectively reviewed records of patients (aged ≥12 years) who were newly diagnosed with EoE between January 2009 and December 2019. EoE diagnosis was confirmed by esophageal biopsy demonstrating a peak eosinophil count ≥15 eosinophils/high-power field (eos/hpf) within 90 days before or after the documented diagnosis (index). Included patients had ≥1 follow-up endoscopy with biopsy and known eosinophil count within 24 months. Data on demographics, clinical characteristics, treatment, and health outcomes were collected 12-month preindex to the last record entry/death. Overall, 415 patients mean age (SD): 31.8 (14.6) years were included. The mean (SD) diagnostic delay from symptom onset was 3.4 (4.8) years median (range): 1.7 (0.7-4.0). The average eosinophil count was 41.4 eos/hpf; 80.2% of patients had endoscopic abnormalities of the esophagus at diagnosis. Post-EoE diagnosis, 77.1% of patients received proton-pump inhibitors, 68.2% swallowed topical corticosteroids, 48.4% made dietary modifications, and 18.8% had esophageal dilation. At diagnosis, 74.5% of patients had dysphagia and 46.0% had heartburn. After diagnosis, 63.5%, 62.2%, and 57.6% did not achieve histologic remission (<15 eos/hpf) at the first, second, and third endoscopy, respectively. Patients with EoE experience a substantial disease burden, with a significant delay in diagnosis. Achieving optimal disease control remains an unmet need with conventional nonbiologic therapies.