Time to eosinophilic oesophagitis diagnosis for patients presenting with upper gastrointestinal symptoms in primary and secondary care

Objective Patients with eosinophilic oesophagitis (EoE) may experience diagnostic delays. This study quantifies the time to EoE diagnosis and examines associated factors. Method A retrospective cohort study was conducted between 2006 and 2022 using Clinical Practice Research Datalink linked to Hospital Episode Statistics. Patients were followed from first proton pump inhibitor (PPI) prescription or presentation in primary or secondary care with EoE-related symptoms (food bolus obstruction (FBO) or dysphagia) to diagnosis. A Robust Poisson regression model examined factors influencing diagnostic delay. Results Of 2300 EoE patients (67.7% male; median age 38 (IQR 30–49)), the median time to diagnosis was 3.6 (IQR 0.5–8.8) years. Before diagnosis, 80.7% patients had a record of PPI prescription in primary care, with a median delay of 4.9 (IQR 1.5–9.7) years. Factors associated with more than 3 years to diagnosis included female (adjusted risk ratio (aRR) 1.14, 95% CI 1.06 to 1.22); PPI prescription in primary care (2.27, 1.87 to 2.75); urgent endoscopy for dysphagia (0.77, 0.62 to 0.95), urgent endoscopy for FBO (0.86, 0.72 to 1.03) and dysphagia presentation in primary care (0.69, 0.62 to 0.77). Following diagnosis, 77% of patients received a PPI prescription, and 21% without asthma or chronic obstructive pulmonary disease were prescribed a steroid inhaler, presumably for EoE. Conclusions The median time to EoE diagnosis was 3.6 years. Longer time to EoE diagnosis was associated with being female and PPI prescriptions in primary care. In contrast, presentations involving FBO and dysphagia, whether in primary or secondary care settings, were associated with a shorter time to EoE diagnosis.