Diagnostic Delay in Patients with Eosinophilic Esophagitis Has Not Changed since First Description 30 Years Ago.

BACKGROUND AND AIMS

Eosinophilic esophagitis (EoE) is a chronic-progressive disease. Diagnostic delay (DD) is associated with increased risk of esophageal strictures and food impactions. We aimed to assess the evolution of DD since EoE's first description in 1993 until 2021.

METHODS

We analyzed data from patients prospectively included in the Swiss EoE Database. DD was calculated as time-interval between the first occurrence of EoE-symptoms and the confirmed diagnosis. DD was analyzed annually over time (1989-2021) and according to mile stone publications in the field (1993: first description; 2007: first consensus recommendations; and 2011: updated consensus recommendations). In addition, a cox proportional hazards model has been used to describe the relation between diagnostic delay and covariates.

RESULTS

Complete data of n=1152 patients (male = 857, 74%; median age at diagnosis = 38 years, interquartile range (IQR): 28-49, range, 1-86) were analyzed. Overall, median DD was 4 years (IQR: 1-11, range, 0-56) with DD ≥10 years in 32% of the population. Over time, DD did not significantly change, neither annually, nor according to release dates of mile stone publications with a persistently stable fraction of roughly a third of all patients with a DD of ≥10 years. Both, age at diagnosis (p<0.001, with an increase in DD up to the age of 31-40) and at symptom onset (younger patients had a longer DD; p<0.001) were significantly associated with DD.

CONCLUSIONS

DD has not changed since EoE's first description almost 30 years ago and remains substantial. Even today a third of patients has a persistently high DD of ≥10 years. Substantial efforts are warranted to increase awareness for EoE and its hallmark symptom, solid-food dysphagia, as an age-independent red-flag symptom amongst health-care professionals and presumable the general population alike in order to lower risk of long-term complications.