Clinical symptoms, comorbidities, treatment patterns and time to diagnosis in patients with eosinophilic oesophagitis in England: a retrospective cohort study

Objective Describe clinical characteristics, treatment patterns, time to diagnosis and development of strictures in patients diagnosed with eosinophilic oesophagitis (EoE) between January 2014 and October 2020 in England. Design/Method Routinely collected data were sourced from three linked databases in England: Clinical Practice Research Datalink (CPRD) Aurum; Hospital Episode Statistics (HES); and Office for National Statistics mortality files. Eligible patients in the CPRD, who could be linked to HES data, had ≥1 diagnosis of EoE, recorded using a diagnostic code during the study period, and ≥12 months (baseline period) continuous registration with the practice before diagnosis, during which EoE-related symptoms and comorbidities were evaluated. Results Patients with EoE (n=2381) more frequently reported dysphagia (40.0% vs 0.2%), acid reflux/heartburn (21.6% vs 0.9%; including gastro-oesophageal reflux disease), abdominal pain (10.8% vs 2.9%) and food impaction (8.2% vs 0.0%) during baseline than age-matched and sex-matched controls (n=9365). The most common first-line and second-line therapies were proton pump inhibitor (PPI) monotherapy and PPI plus swallowed topical corticosteroids, respectively. Median (IQR) time from first recorded symptom to diagnosis was 4.5 (1.3 to 16.4) months. Patients with prolonged time to diagnosis (≥24 months) more frequently reported EoE-related comorbidities and were younger (<18 years) than those with shorter time to diagnosis (<24 months). Patients who developed strictures ≤3 years after diagnosis were more frequently men and more frequently reported food impaction or dysphagia at baseline. Conclusion This study helps characterise patients with EoE who require closer monitoring, highlighting the need for earlier diagnosis and treatment.