There is under-recognized variation in care and management, specifically the frequency of endoscopic monitoring, among children with eosinophilic esophagitis (EoE), according to a study published in Journal of Pediatric Gastroenterology and Nutrition.

Researchers used data from the Pediatric Health Information System over a 15-year period for ambulatory esophagogastroduodenoscopy (EGD) in children with EoE. Patients with at least 1 year of data were included and information on age, sex, ethnicity, race, insurance type, median household income, and atopy was collected.

Overall, 16,517 patients were included with a mean age of 8.5 years at their first encounter and median age of 9 years. The number of patients with at least 1 EGD per subject year (SY) was 3211 (19%); univariate analysis showed that patients with ≥1 EGD/SY were significantly older than those with <1 EGD/SY.


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Multivariate analysis showed that compared with patients aged 6 to 12 years, those aged <2 years were more likely to have ≥1 EGD/SY (odds ratio [OR], 1.35; 95% CI, 1.13-1.62; P <.001). Other ages more likely to have ≥1 EGD/SY compared with patients aged 6 to 12 years were patients aged 2 to 5 years (OR, 1.33; 95% CI, 1.19-1.48; P <.001) and >13 years (OR, 2.29; 95% CI, 2.06-2.54; P <.001).

Boys were more likely than girls to have ≥1 EGD/SY (OR, 1.19; 95% CI, 1.08-1.31; P <.001) and Black patients were 16% less likely than White patients to have ≥1 EGD/SY (OR, 0.84; 95% CI, 0.71-1.00; P =.05).

Other factors associated with a higher likelihood of having ≥1 EGD/SY were allergic rhinitis (OR, 1.67; 95% CI, 1.47-1.90; P <.001) and other allergies such as anaphylaxis, food allergy, oral allergy syndrome, and allergy not specified (OR, 3.65; 95% CI, 3.25-4.11; P <.001).

Study limitations include its retrospective nature and lack of clinical information as to why patients had repeat EGDs.  Additionally, there remained the risk of miscoding diagnoses based on the system used. Finally, cities with multiple tertiary care centers were underrepresented in the data set.

Investigators concluded, “Identifying demographic and socioeconomic factors that affect endoscopy utilization in children with EoE is valuable, and this study raises awareness about underrecognized variation in care.”

Reference

Bose P, Hon EC, Vitalpur GV, Bennet Jr WE. The effects of patient demographics on outpatient endoscopy utilization in children with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2021;73(4):537-541. doi: 10.1097/MPG.0000000000003162.