Eosinophilic Esophagitis Rates Continue to Rise in Denmark

Despite being lower than most European countries, the rate of eosinophilic esophagitis (EoE) continues to increase in Denmark, particularly among men and older individuals.

A team, led by Kristine Højgaard Allin, Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, estimated the incidence and prevalence of EoE in Demark between 2008-2018.

EoE in Denmark

EoE incidence rates have increased in the western world in pediatric patients since 1981 and in adult patients since 1993. However, the incidence of disease in Denmark between 1997-2012 is considered lower than other European countries.

“This study of the entire population of Denmark during the period 2008 to 2018 shows that the incidence and prevalence of EoE is not yet plateauing and that EoE could be severely underdiagnosed, especially in children,” the authors wrote.

However, there remains a lack of population-based studies on estimates of EoE incidence and prevalence.

In the study, the investigators identified cases of EoE using data from nationwide registers in Denmark. The cases were based on a broad definition of EoE based entirely on esophageal biopsies from the Danish Pathology Register and a narrow definition that included symptoms of esophageal dysfunction registered in the Danish National Patient Registry.

A Large Population Sample

Over the course of the 10 year study, 119,268 esophageal biopsies were performed on 81,255 individuals in Denmark. Of this group, 4011 had a first diagnosis of EoE based on the broad definition, 69% (n = 2749) of which had at least 1 recording symptom of esophageal dysfunction at the time of sampling, fulfilling the narrow EoE definition as well.

The team then standardized the annual incidence and prevalence by sex and age in 5 year intervals to the 2013 study population.

Trends in EoE Prevalence

The results show the standardized incidence of EoE was stable from 2008-2011. However, it increased from 3.9 per 100,000 person-years (95% CI, 3.3-4.4) in 2011 to 11.7 per 100,000 person-years (95% CI, 10.8-12.6) in 2018.

There were similar trends found when using the narrow EoE definition.

The investigators also reported on trends on age and sex.

For example, the increase in EoE incidence was most pronounced in men and for patients aged 40 years and older.

For pediatric patients, the EoE incidence was 4.4 per 100,000 person-years (95% CI, 3.2-5.6), which is significantly lower than the incidence rate of 17.6 per 100,000 person-years (95% CI, 15.7-19.5) for individuals aged between 40-64 years.

Geographic trends were also identified.

The EoE incidence rate varied substantially across the 5 distinct regions of Denmark.

Finally, the biopsy rate and the proportion of esophageal biopsies with detected eosinophilia increased over the course of the study.

“This study of the entire population of Denmark during the period 2008 to 2018 shows that the incidence and prevalence of EoE is not yet plateauing and that EoE could be severely underdiagnosed, especially in children,” the authors wrote.

The study, “Eosinophilic esophagitis in Denmark: Population-based incidence and prevalence in a nationwide study from 2008 to 2018,” was published online in the United European Gastroenterology Journal.