TY - JOUR
T1 - Diagnostic Delay in Patients with Eosinophilic Gastritis and/or Duodenitis
T2 - A Population-Based Study
AU - Chehade, Mirna
AU - Kamboj, Amol P.
AU - Atkins, Dan
AU - Gehman, Lauren T.
N1 - Funding Information:
Allakos, Inc. was the sponsor and funding source of the study.Conflicts of interest: M. Chehade received research support from the National Institutes of Health (R01-AI140133, U54-AI117804), American Partnership for Eosinophilic Disorders/American Academy of Allergy, Asthma, and Immunology, Shire, Regeneron, Allakos, AstraZeneca, and Danone; consulting fees from Shire/Takeda, Regeneron, Allakos, Adare, AstraZeneca, Sanofi, and Bristol Myers Squibb; lecture honoraria from Nutricia, Medscape, and Vindico. A. P. Kamboj is a full-time employee of Allakos, Inc.; owns stocks and stock options; and is named on patents for the company. D. Atkins received consulting fees from Allakos and DBV and lecture honoraria from Seahec. L. T. Gehman is a full-time employee of Allakos, Inc. and owns stocks and stock options for the company.The study was sponsored by Allakos, Inc. All authors had full access to the raw data, were responsible for the content of the manuscript, and approved the manuscript for publication. The authors thank Jingwen Tan, PhD, an employee of Allakos, for data analytics support and Jocelyn Hybiske, PhD, an independent consultant who received payment from the study's sponsor, for writing and editorial assistance. The manuscript was reviewed and approved by all coauthors. All the authors vouch for the accuracy and completeness of the data and for the adherence of the trial to the protocol. MC and LTG designed and planned the study, interpreted the data, and drafted the manuscript. DA and APK contributed to study design ideas, interpretation of the data/findings, and provided writing and editing support. The first draft of the article was written by the first and last authors with editorial assistance provided by Jocelyn Hybiske, PhD, an independent consultant funded by Allakos, Inc.
Publisher Copyright:
© 2021 The Authors
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Eosinophilic enteritis
KW - Eosinophilic esophagitis
KW - Eosinophilic gastroenteritis
KW - Eosinophilic gastrointestinal disease
UR - http://www.scopus.com/inward/record.url?scp=85100443611&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2020.12.054
DO - 10.1016/j.jaip.2020.12.054
M3 - Article
C2 - 33440255
AN - SCOPUS:85100443611
SN - 2213-2198
VL - 9
SP - 2050-2059.e20
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 5
ER -