Esophagus to Small Intestine

Clin Gastroenterol Hepatol. 2023;21(12):3041–50.e3

Lam AY, Lee JK, Coward S, Kaplan GG, Dellon ES, Bredenoord AJ, Jairath V, Crowley E, Gupta M, Jijon H, Nasser Y, Andrews CN, Chehade M, Gonsalves N, Hirano I, Ma C

Epidemiologic burden and projections for eosinophilic esophagitis-associated emergency department visits in the United States: 2009–2030


Background and aims: Patients with poorly controlled eosinophilic esophagitis (EoE) may require unplanned emergency department (ED) visits for the management of dysphagia or food impactions. The authors evaluated the epidemiologic burden of EoE on ED utilization in the United States.
Methods: Data from the US Nationwide Emergency Department Sample were used to estimate weighted annual EoE-associated ED visits from 2009 to 2019. Temporal trends in population-adjusted rates of EoE visits were assessed using joinpoint regression. Autoregressive integrated moving average models were used to project EoE-associated ED visits to 2030. The authors also evaluated endoscopic utilization, requirement for hospitalization, and ED-related charges in patients with EoE presenting to the ED.
Results: A total of 11,125 unweighted (49,507 weighted) ED visits for EoE were included (69.0% male; mean age, 32.4 years). The annual volume of EoE-associated ED visits increased from 2934 (95% confidence interval [CI]: 2437–3431) in 2009 to 8765 (95% CI: 7514–10,015) in 2019, and is projected to reach 15,445 (95% prediction interval: 14,672–16,218) by 2030. From 2009 to 2019, the number of EoE-associated ED visits increased by an average of 11.5% per year (95% CI: 10.3–12.7%). The proportion of patients admitted to the hospital from the ED decreased from 25.6% in 2009 to 2011 to 14.0% in 2017 to 2019. Half of EoE patients presenting to the ED required an endoscopy, and nearly 40% required an esophageal foreign body removal. Total mean inflation-adjusted charges for an EoE-associated ED visit were 9025 US dollars in 2019.

Conclusions: The volume of eosinophilic esophagitis (EoE)-associated emergency department visits tripled between 2009 and 2019 and is projected to further double by 2030. This represents a substantial burden of unanticipated health care resource utilization and highlights a potential opportunity to optimize outpatient EoE care.

Assoc. Prof. Dr. C. Ma, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, E-Mail: christopher.ma@ucalgary.ca

DOI: 10.1016/j.cgh.2023.04.028

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