Mirna Chehade1, Amol P Kamboj2, Dan Atkins3, Lauren T Gehman2. 1. Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: mirna.chehade@mssm.edu. 2. Allakos Inc., Redwood City, Calif. 3. Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
Abstract
BACKGROUND: Eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD) is characterized by persistent symptoms and elevated eosinophils in the gastrointestinal tract. Limited disease awareness and lack of diagnostic guidelines suggest that patients may remain undiagnosed or endure diagnostic delay. OBJECTIVE: To characterize the path to diagnosis for patients with EG/EoD in a representative population. METHODS: In this observational cohort study, 4108 eligible patients diagnosed with EG/EoD between 2008 and 2018 were identified in an administrative claims database in the United States. Patient medical claim history was analyzed to describe events related to diagnosis. RESULTS: Mean year from symptom presentation to diagnosis of EG/EoD was 3.6; factors contributing to diagnostic delay included delayed gastroenterologist referral, delayed esophagogastroduodenoscopy (EGD), and lack of biopsy collection and/or histopathologic evaluation. Missed diagnosis on index EGD occurred in 38.2% of patients, resulting in a mean increase of 1.6 years in time to diagnosis versus patients diagnosed on index EGD. Patients presented with nonspecific symptoms and 44.3% were diagnosed with another gastrointestinal condition before EG/EoD diagnosis. Independent predictors of >2-year diagnostic delay included adult age; prior diagnosis of irritable bowel syndrome, functional dyspepsia, or gastric/peptic ulcer; use of other procedures such as colonoscopy; presence of edema; and history of certain allergic diseases. CONCLUSIONS: This study found that patients with EG/EoD experienced an average of 3.6 years between initial symptom presentation and diagnosis and revealed several factors contributing to diagnostic delay. We hope that these findings, together with heightened awareness and standardization of diagnostic guidelines, will improve the diagnostic journey of patients with EG/EoD.
BACKGROUND:Eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD) is characterized by persistent symptoms and elevated eosinophils in the gastrointestinal tract. Limited disease awareness and lack of diagnostic guidelines suggest that patients may remain undiagnosed or endure diagnostic delay. OBJECTIVE: To characterize the path to diagnosis for patients with EG/EoD in a representative population. METHODS: In this observational cohort study, 4108 eligible patients diagnosed with EG/EoD between 2008 and 2018 were identified in an administrative claims database in the United States. Patient medical claim history was analyzed to describe events related to diagnosis. RESULTS: Mean year from symptom presentation to diagnosis of EG/EoD was 3.6; factors contributing to diagnostic delay included delayed gastroenterologist referral, delayed esophagogastroduodenoscopy (EGD), and lack of biopsy collection and/or histopathologic evaluation. Missed diagnosis on index EGD occurred in 38.2% of patients, resulting in a mean increase of 1.6 years in time to diagnosis versus patients diagnosed on index EGD. Patients presented with nonspecific symptoms and 44.3% were diagnosed with another gastrointestinal condition before EG/EoD diagnosis. Independent predictors of >2-year diagnostic delay included adult age; prior diagnosis of irritable bowel syndrome, functional dyspepsia, or gastric/peptic ulcer; use of other procedures such as colonoscopy; presence of edema; and history of certain allergic diseases. CONCLUSIONS: This study found that patients with EG/EoD experienced an average of 3.6 years between initial symptom presentation and diagnosis and revealed several factors contributing to diagnostic delay. We hope that these findings, together with heightened awareness and standardization of diagnostic guidelines, will improve the diagnostic journey of patients with EG/EoD.
Authors: Evan S Dellon; Nirmala Gonsalves; J Pablo Abonia; Jeffrey A Alexander; Nicoleta C Arva; Dan Atkins; Stephen E Attwood; Marcus K H Auth; Dominique D Bailey; Luc Biederman; Carine Blanchard; Peter A Bonis; Paroma Bose; Albert J Bredenoord; Joy W Chang; Mirna Chehade; Margaret H Collins; Carlo Di Lorenzo; Jorge Amil Dias; Ranjan Dohil; Christophe Dupont; Gary W Falk; Cristina T Ferreira; Adam T Fox; Robert M Genta; Thomas Greuter; Sandeep K Gupta; Ikuo Hirano; Girish S Hiremath; Jennifer L Horsley-Silva; Shunji Ishihara; Norihisa Ishimura; Elizabeth T Jensen; Carolina Gutiérrez-Junquera; David A Katzka; Paneez Khoury; Yoshikazu Kinoshita; Kara L Kliewer; Sibylle Koletzko; John Leung; Chris A Liacouras; Alfredo J Lucendo; Lisa J Martin; Emily C McGowan; Calies Menard-Katcher; David C Metz; Talya L Miller; Fouad J Moawad; Amanda B Muir; Vincent A Mukkada; Simon Murch; Quan M Nhu; Ichiro Nomura; Samuel Nurko; Yoshikazu Ohtsuka; Salvatore Oliva; Rok Orel; Alexandra Papadopoulou; Dhyanesh A Patel; Robert D Pesek; Kathryn A Peterson; Hamish Philpott; Philip E Putnam; Joel E Richter; Rachel Rosen; Melanie A Ruffner; Ekaterina Safroneeva; Philipp Schreiner; Alain Schoepfer; Shauna R Schroeder; Neil Shah; Rhonda F Souza; Stuart J Spechler; Jonathan M Spergel; Alex Straumann; Nicholas J Talley; Nikhil Thapar; Yvan Vandenplas; Rajitha D Venkatesh; Mario C Vieira; Ulrike von Arnim; Marjorie M Walker; Joshua B Wechsler; Barry K Wershil; Benjamin L Wright; Yoshiyuki Yamada; Guang-Yu Yang; Noam Zevit; Marc E Rothenberg; Glenn T Furuta; Seema S Aceves Journal: Clin Gastroenterol Hepatol Date: 2022-02-16 Impact factor: 13.576
Authors: Marc E Rothenberg; Shawna K B Hottinger; Nirmala Gonsalves; Glenn T Furuta; Margaret H Collins; Nicholas J Talley; Kathryn Peterson; Calies Menard-Katcher; Macie Smith; Ikuo Hirano; Robert M Genta; Mirna Chehade; Sandeep K Gupta; Jonathan M Spergel; Seema S Aceves; Evan S Dellon Journal: J Allergy Clin Immunol Date: 2021-12-22 Impact factor: 10.793
Authors: David J Jackson; Praveen Akuthota; Rebeca Andradas; Albert J Bredenoord; Amanda Cordell; Sarah Gray; Joyce Kullman; Sameer K Mathur; Ian Pavord; Florence Roufosse; Christian Rubio; Irena Clisson Rusek; Dagmar Simon; Mary Jo Strobel; Tonya Winders Journal: Adv Ther Date: 2022-04-30 Impact factor: 4.070