P2401 - Eosinophilic Esophagitis: Have the U.S. Guidelines Made a Difference for Inpatient Outcomes?

Paul T. Kroner, MD, MSc¹, Joshua Kwon, MD¹, Andree Koop, MD¹, Lydia A. Mercado, MD¹, Giovani Schwingel, MD², Marco D'Assuncao, MD³, Juan Pablo Gutierrez, MD⁴, Alvaro Martinez, MD⁵, Klaus E. Mönkemüller, MD, PhD⁶, Maoyin Pang, MD, PhD¹, Dawn Francis, MD, MHS¹, Kenneth R. DeVault, MD^1
1Mayo Clinic, Jacksonville, FL; ²Cemox, Porto Alegre, Rio Grande do Sul, Brazil; ³Hospital Sirio Libanes, Sao Paulo, Sao Paulo, Brazil; ⁴Hospital Italiano, Montevideo, Montevideo, Uruguay; ⁵Hospital Universitario de Valme, Sevilla, Andalucia, Spain; ⁶Helios Frankenwald Klinikum, Kronach, Bayern, Germany

Introduction: Though EoE has been recognized as a distinct clinical entity for nearly 30 years, the first consensus and US guidelines were proposed in 2007 and 2013, respectively. A subset of patients who are untreated or in whom treatment is not effective may develop complications leading to hospital visits, requiring emergent upper endoscopy (EGD). The aim of our study was to examine temporal trends in cases and complications of EoE leading to admission before and after the first US guidelines.

Methods: Retrospective observational study using the NIS 2009-2018. Analysis before the year 2009 was deemed inaccurate, as no specific ICD code for EoE existed. Patients with a principal diagnostic ICD9/10-CM code for EoE were included. The primary outcome was the temporal trend in hospital admissions for EoE in the designated time periods. Secondary outcomes were the associated trend in occurrence of food bolus impaction (FBI), the use of EGD, and its complications including strictures requiring dilation or esophageal perforation (EP). Multivariate analysis yielded odds ratios adjusted for confounders. The top 5 diagnoses in the patient cohort were explored. To account for multiple calculations, a p-value of < 0.0125 was considered significant after Bonferroni correction.

Results: 25,585 admissions related to EoE were included. The total yearly number increased from 1,804 in 2009 to 3,005 in 2018. The mean patient age was 37.8 (39.8% female). The odds of admission for EoE substantially increased in the study period (aOR:1.24, p< 0.001). In comparing pre- and post-EoE US guideline outcomes, the odds of admission for EoE, as well as esophageal biopsies increased, while the odds of esophageal FBI, EP or dilation were not significantly different (Table 1). The odds of EGD, esophageal FBI, dilation, biopsies or esophageal perforation were no different in 2018 compared to 2009. In patients undergoing EGD, patients with EoE had higher odds of FBI, perforation, biopsy and dilation (Table 1). The top 5 GI-related diagnoses were FBI (23.1%), GI bleed (15.9%), EP (7.7%), dehydration (7.3%), and stricture (7.0%).

Discussion: The increased numbers and odds of EoE admissions likely reflects the increased frequency with which the diagnosis was made supported by the increased frequency of performance of esophageal biopsies, specifically in the period subsequent to the US guideline publication. Rates and odds of complications remained unchanged in the study period.



Disclosures:


Paul T. Kroner, MD, MSc¹, Joshua Kwon, MD¹, Andree Koop, MD¹, Lydia A. Mercado, MD¹, Giovani Schwingel, MD², Marco D'Assuncao, MD³, Juan Pablo Gutierrez, MD⁴, Alvaro Martinez, MD⁵, Klaus E. Mönkemüller, MD, PhD⁶, Maoyin Pang, MD, PhD¹, Dawn Francis, MD, MHS¹, Kenneth R. DeVault, MD¹. P2401 - Eosinophilic Esophagitis: Have the U.S. Guidelines Made a Difference for Inpatient Outcomes?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.