S993 Increasing Incidence of Eosinophilic Esophagitis in the United States Between 2014-2024: A TriNetX Study

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by eosinophilic infiltration and inflammation of the esophagus. While recent studies have demonstrated increasing incidence and prevalence of EoE, these have largely utilized data from individual centers or administrative databases in variable patient populations. The study aim was to examine epidemiological trends in EoE using a large, population-based database. Methods: This retrospective cohort study included patients with EoE in TriNetX, a national database encompassing 66 healthcare organizations, between January 2014 and December 2024. Inclusion criteria required patients to have a Current Procedural Terminology code (43235, 43239, 43247-43249) for esophagogastroduodenoscopy (EGD) prior to EoE diagnosis which was defined using International Classification of Diseases-10 codes (K20.0). Data was collected on patient age, sex, race, and ethnicity, as well as atopic conditions. Negative binomial regression was used to evaluate trends. Results: A total of 87,359 patients were diagnosed with EoE between 2014-2024 (age 39±21 years, 59% men, 79% White). The incidence of EoE increased from 0.15% in 2014 to 0.60% in 2024 and the prevalence increased from 0.55% to 3.24% during the study period. The increase in EoE incidence between 2014-2024 was seen across different subgroups including by gender (men, 0.24% to 0.93%; women, 0.10% to 0.42%), age (18-49 years, 0.33% to 1%; ≥50 years, 0.08% to 0.27%), race (White, 0.18% to 0.67%; Black, 0.09% to 0.37%; Asian, 0.05% to 0.32%), and ethnicity (Hispanic or Latino 0.07% to 0.50%; Non-Hispanic or Latino, 0.16% to 0.62%). The incidence of atopic conditions also increased during the study period (asthma, 1.7% to 1.9%; eczema, 0.14% to 0.31%; and food allergies, 0.14% to 0.42%). Conclusion: This large national, population-based study highlights a 4-fold increase in incidence and 6-fold increase in prevalence of EoE between 2014-2024 utilizing data from the TriNetX database. The increasing incidence in EoE was also observed across different subgroups including by age, gender, race, and ethnicity, and paralleled an increase in incidence of other atopic conditions during the study period. While this increase in EoE incidence may be, in part, due to increasing awareness of EoE and more frequently taken esophageal biopsies, further studies are needed to better elucidate factors contributing to the increasing incidence.