Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States.
OBJECTIVE
Variation in the prevalence of eosinophilic gastrointestinal diseases in different geographical regions has not been extensively studied. The aim of the present study was to define the regional and national prevalence of eosinophilic gastrointestinal diseases, and differences in practice approaches.


METHODS
We administered a survey electronically to members of the American College of Gastroenterology, the American Academy of Allergy, Asthma, and Immunology, and the North American Society Pediatric Gastroenterology, Hepatology, and Nutrition. Questions pertained to the number and proportion of patients seen with eosinophilic gastroenteritis or colitis and eosinophilic esophagitis (EoE), and methods used to diagnose and treat these conditions.


RESULTS
A total of 1836 physicians responded from 10,874 requests (17% response). Extrapolating responses from our US sample, we estimated an overall prevalence of 52 and 28/100,000 for EoE and eosinophilic gastroenteritis or colitis. The patient burden of EoE is higher in urban (0.58) and suburban (0.44) compared with rural settings (0.36, P < 0.0065), observations consistent with other allergic disorders. There was also increased prevalence in northeast region when calculated by prevalence per 100,000. There was considerable variability in criteria and initial treatment options used to diagnose EoE. Only one-third of respondents reported using diagnostic criteria proposed in a 2007 consensus document. Seventy-one and 35% of respondents reported treating some patients with EoE with a food elimination or elemental diet, respectively.


CONCLUSIONS
EoE is diagnosed more often in northeastern states and urban areas. There is considerable variability in diagnostic criteria and initial treatment approach supporting the need for additional clinical trials and consensus development.
Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. spergel@email.chop.edu
Jonathan M
JM
Spergel
Wendy M
WM
Book
Elizabeth
E
Mays
Lihal
L
Song
Samir S
SS
Shah
Nicholas J
NJ
Talley
Peter A
PA
Bonis
D004035:Diet Therapy; D004751:Enteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004802:Eosinophilia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005756:Gastritis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006306:Health Surveys; D006801:Humans; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014504:Urban Health