S932 National Trends in Eosinophilic Esophagitis and Use of Endoscopic Dilation: A Nationwide Inpatient Analysis

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease that has seen increased recognition in recent years. Despite the growing burden of this disease, national trends in diagnosis rates and utilization of endoscopic dilative procedures remain underreported. This study aims to explore differences in patient and hospital characteristics among those undergoing dilative procedures using the Nationwide Inpatient Sample (NIS) database. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database from 2018 to 2021. Patients diagnosed with EoE were identified using International Classification of Diseases (ICD)-10-CM code and were stratified based on undergoing endoscopic dilative procedure using ICD-10-PCS codes. T-test and Chi-square test were used to compare patients and hospital characteristics between groups and logistic regression analysis was used to assess possible predictors. Survey weights were applied to account for the complex survey design of the NIS. Results: Among 27,390 EoE-related hospitalizations from 2018 to 2021, 1,345 (4.9%) patients underwent endoscopic dilation. Those who underwent dilation were significantly older (mean age: 51 vs 36 years; P < 0.001) and more likely to have Medicare insurance (34.6% vs 18.8%; P = 0.001) or reside in the lowest income quartile (27.9% vs 20.3%; P = 0.001). Dilation was also more frequent in urban-teaching hospitals (77.7%). Asthma was less common among those receiving dilation (12.6% vs 25.1%; P < 0.001), while smoking was more prevalent (12.2% vs 5.5%). Multivariable regression confirmed that increasing age (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.02-1.04), smoking (OR 1.56; 95% CI 1.04-2.34), and lower income (quartile 4 vs quartile 1: OR 0.59; 95% CI 0.39-0.88) were independently associated with dilation, while asthma was inversely associated (OR 0.63; 95% CI 0.43-0.93). Conclusion: EoE patients who underwent dilation were older and more often covered by Medicare, suggesting more advanced disease. Most procedures occurred at urban teaching hospitals, likely due to availability of advanced endoscopy. Higher dilation rates in lower-income groups may indicate delayed presentation possibly due to barriers in access to care. Smoking was more common and asthma less frequent among those dilated, possibly due to smoking-related gastroesophageal reflux disease promoting strictures and asthma treatments improving EoE control. Further research is needed to better understand these associations and reduce related disparities. Artificial intelligence was used to refine language only.