Author(s): Syed AA, Andrews CN, Shaffer E, Urbanski SJ, Beck P,
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Abstract BACKGROUND: Eosinophilic oesophagitis (EoE) has evolved from a supposedly rare entity to one whose incidence rates are approaching that of inflammatory bowel disease. The factors responsible for this apparent increase in the incidence remain obscure. AIM: To assess various endoscopist and pathologist factors that might affect the frequency of EoE being detected in a well-defined North American population. HYPOTHESIS: Increased endoscopist and pathologist awareness has contributed to the increased clinical recognition of EoE. METHODS: Cases of EoE were identified systematically using population-based pathology and endoscopy databases from January 2004 to December 2008 in Calgary, Canada (population 1.25 million). EoE frequency was estimated with time trend analysis. Characteristics of individual endoscopists (n = 45) were compared with diagnostic rates. RESULTS: Crude population incidence of EoE increased from 2.1 per 10(5) in 2004 to 11.0 per 10(5) in 2008: an annual increase of 39\% (P < 0.0001). The frequency in men was 4.5 times higher than in women (95\% CI: 3.51-5.76). In patients presenting with dysphagia oesophageal biopsy rates increased from 17.0\% in 2004 to 41.3\% of EGDs in 2008: an annual rise of 26\% (P < 0.0001). On multivariate regression analysis, those endoscopists with higher biopsy rates were more likely to make the diagnosis of EoE (P = 0.008). To include or exclude the diagnosis, typical histological features of EoE were reported more often by pathologists in 2008 as compared to 2004 (P = 0.01 & P < 0.0001 respectively). CONCLUSIONS: The incidence of eosinophilic oesophagitis continues to rise in the general population, in part due to increasing oesophageal biopsy rates and a more detailed histological evaluation of specimens. The biopsy rate of an endoscopist is an indicator for a higher diagnostic yield. © 2012 Blackwell Publishing Ltd.
This article was published in Aliment Pharmacol Ther
and referenced in Journal of Hepatology and Gastrointestinal disorders