gutsandgrowth

Home | About Jay Hochman -Pediatric Gastroenterology Blog | Archives

The Story Behind a 30 Year Esophagitis Study

December 8, 2015 7:00 am

A recent retrospective study ( SS Baker et al. JPGN 2015; 61: 538-40) reported on changes in esophagitis over a 30 year period at one center.  While the authors focus on the fluctuating percentage of esophagitis noted during three periods, in my opinion, they miss the opportunity to discuss more relevant findings.

Specifically, the authors note the following:

• From 1980-88 (n=186 over 8 years) that 26.9% had esophagitis and 4.8% had >15 eos/hpf.  Normal pathology in the esophagus was noted in 73.1%.
• From 2000-2002 (n=321 over 2 years), 41.2% had esophagitis and 8.5% had >15 eos/hpf.  Normal pathology in the esophagus was noted in 58.8%.
• In the most recent period, 2011, (n=675 over 1 year), 31%* had esophagitis and 12.7% had >15 eos/hpf.  Normal pathology in the esophagus was noted in 69%.     *erroneously reported as 33%

What is baffling to me are the following:

• Why the authors assert that there has been a fluctuating prevalence.  In absolute terms, the increase in cases is marked, though one can argue that in earlier periods there may have been many undiagnosed cases.
• Why the authors do not comment on the tremendous increase in the use of endoscopy in their discussion.  In the first period, they were averaging ~23/year, the second period ~95/year and in the most recent period, they performed 675 in one year.

My take: This study shows that esophageal eosinophilia has been present for a long time and that identification of cases has increased considerably over 32 years.  In addition, the use of endoscopy has increased markedly, yet the yield of abnormal findings remains similar.

Briefly noted: C Menard-Katcher et al. JPGN 2015; 61: 541-46.  This retrospective study of 22 children showed that 55% had esophageal strictures identified by esophagram but not endoscopy.

Related blog posts:

• How Common is Eosinophilic Esophagitis? | gutsandgrowth
• Looking Twice for Eosinophilic Esophagitis | gutsandgrowth
• Higher Doses of Topical Steroids for Eosinophilic… | gutsandgrowth
• Putting in Place a Big Piece of the Eosinophilic… | gutsandgrowth

Posted by gutsandgrowth

Categories: Pediatric Gastroenterology Intestinal Disorder

Tags: Eosinophilic esophagitis, epidemiology, esophagram, stricture

« Older Newer »

2 Responses to “The Story Behind a 30 Year Esophagitis Study”

1. Agree and think a lot of this increase has to do with pathologists counting eos which only began universally after first consensus recommendations (2007).

   By Seth Marcus on December 8, 2015 at 7:54 am

2. […] The Story Behind a 30 Year Esophagitis Study […]

   By Why Are So Many “Low Value” Endoscopies Performed? | gutsandgrowth on April 14, 2016 at 7:05 am

Mobile Site | Full Site

Get a free blog at WordPress.com Theme: WordPress Mobile Edition by Alex King.