P1822 - Age Significantly Impacts the Timely Diagnosis of Eosinophilic Esophagitis Amongst Elderly Patients

Evan S. Dellon, MD, MPH¹, Craig C.. Reed, MD, MSCR¹, Akshatha Kiran, MPH^2
1University of North Carolina School of Medicine, Chapel Hill, NC; ²UNC School of Medicine, Chapel Hill, NC

Introduction: We previously illustrated that age may represent a barrier to the diagnosis of eosinophilic esophagitis (EoE). It remains unknown whether this barrier, in part, derives from a difference in phenotype at presentation. In this study, we aimed to determine if the clinical, histologic, or endoscopic presentation of EoE varies between elderly and non-elderly cohorts.

Methods: We conducted a retrospective cohort study using the UNC EoE Clinicopathologic Database from April 2001 - April 2021. To be included in this database, patients must have ≥15 eosinophils per-high power field on esophageal biopsy, symptoms of esophageal dysfunction, and the exclusion of alternative etiologies of esophageal eosinophilia. Patient demographics, clinical characteristics, procedural data, and co-morbidities were extracted. Bivariate and multivariate analyses assessed whether the presentation of EoE varied between elderly and non-elderly cohorts.

Results: We assessed 1,036 patients diagnosed with EoE, 31 (3%) of whom were elderly (≥65 years) (Table). Both groups were predominantly male (61% vs 69%, p=0.38) and white (94% vs 86%, p=0.77), though the symptomatic period preceding diagnosis varied between elderly vs non-elderly patients (15.3 ± 15.4 vs 7.3 ± 7.9, p < 0.001). Clinically, neither the presence of any concomitant atopic condition (26% vs 43%, p=0.06), symptoms prior to diagnosis (including dysphagia, food impaction, heartburn, chest pain, nausea, or vomiting), nor indication for index endoscopy (heartburn, dysphagia, chest pain, or a combination of indications) were significantly different between elderly-EoE and non-elderly EoE patients. On endoscopy, edema (16% vs 39%, p=0.01) and furrows (45% vs 66%, p=0.02) were more common amongst non-elderly EoE patients. Eosinophil counts were comparable between groups (Table). On multivariate analysis, all associations besides symptomatic period prior to diagnosis were attenuated (aOR 1.08, 95% CI: 1.04 - 1.11) (Figure 1).

Discussion: After controlling for covariates, we did not find that elderly patients with EoE differed clinically, endoscopically, or histologically from non-elderly EoE patients. However, time to diagnosis was significantly longer for elderly patients. These data suggest that detection bias may partly explain the decreased incidence of elderly EoE, though additional factors including differential symptom reporting, severity of symptoms, among others should be considered and explored in future work.



Disclosures:


Evan S. Dellon, MD, MPH¹, Craig C.. Reed, MD, MSCR¹, Akshatha Kiran, MPH². P1822 - Age Significantly Impacts the Timely Diagnosis of Eosinophilic Esophagitis Amongst Elderly Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.