Diagnostic delay in eosinophilic esophagitis persists since disease description

To this day, diagnostic delay (DD) remains a problem since the first description of eosinophilic esophagitis (EoE) nearly 30 years ago, reveals a study. Notably, one-third of EoE patients suffer a persistently high DD of at least 10 years.

EoE is a chronic progressive disease, and a delay in its diagnosis may lead to a higher risk of oesophageal strictures and food impactions, according to the authors, who sought to assess the evolution of DD since the first description of EoE in 1993 until 2021.

Data from patients included in the Swiss EoE database were analysed, and DD was calculated as the time interval between the first occurrence of EoE symptoms and the confirmed diagnosis.

The authors analysed DD annually from 1989 to 2021 and according to milestone publications in the field (1993: first description; 2007: first consensus recommendations; and 2011: updated consensus recommendations). They also described the relationship between DD and covariates using a Cox proportional hazards model.

A total of 1,152 patients (median age at diagnosis 38 years, 74 percent male) with complete data were included in the analysis. Overall, median DD was 4 years, with 32 percent of the population having DD ≥10 years.

DD did not significantly change over time, neither annually nor according to the release dates of milestone publications, with a persistently stable proportion of about one-third of all patients with a DD of ≥10 years. DD was significantly associated with age at diagnosis (p<0.001, with an increase in DD up to age 31‒40 years) and at symptom onset (younger patients had longer DD; p<0.001).

“Substantial efforts are warranted to increase awareness for EoE and its hallmark symptom, solid food dysphagia, as an age-independent red-flag symptom among healthcare professionals and presumably the general population alike to lower risk of long-term complications,” the authors said.