This is shown by a recent work developed in an US center specialized in esophageal diseases, after analyzing the impact of the publication of the different clinical practice guides on EoE on the length of symptoms before EoE diagnosis.
The authors aimed to assess whether the symptomatic
period preceding the diagnosis of EoE has decreased over time, as the available knowledge on EoE dramatically increased.
To do that, the researchers conducted a retrospective cohort study utilizing the University of North Carolina EoE Clinicopathologic Database between 2000 and 2014. This database contains data extracted from medical records for incident cases of EoE at this institution. The outcome variable was length of symptoms preceding diagnosis and the independent variable was year of diagnosis.
After contollong for potential confounders (including gender, race, age at diagnosis, dysphagia, history of food impaction, type of symptoms, and concomitant atopic diseases) the authors calculated the predicted length of undiagnosed symptomatic periods for years corresponding with the publication of management guidelines: 2000 – 2006 (before first guidelines), 2007 – 2011 (after first guidelines), and after 2011 (after second guidelines).
A total of 677 EoE cases were included in this study. At diagnosis, the mean age was 26 years (range 1-82), 69% were male, 81% were white and 40% had a history of an atopic condition. Overall, the mean duration of symptoms prior to diagnosis was 7.4 ± 8.7 years.
The authors found, that far from reducing the diagnostic delay over time, it maintained and even increased along the years for the whole series of patients. Thus, the predicted length of symptoms prior to diagnosis from 2000 – 2006 was 6.1 years; for the 2007 – 2011 period the average diagnostic delay was 7.2 years, and it maintained stable for 2011 – 2014 period.
These findings were unchanged after stratification by child versus adult status. The length of symptoms prior to diagnosis for adults from 2000 – 2006, 2007 – 2011, and 2011 – 2014 was 8.3, 10.1, and 10.2 years. A similar pattern for children was found in the corresponding years with predicted symptomatic periods of 2.8, 3.5, 3.7years, respectively.
According to this study, the duration of symptoms that patients suffer before reaching a diagnosis of EoE remains unacceptably long. Far from being reduced, it could even continue to increase, both in children and adults. Therefore, greater efforts should be made to raise awareness about this disease at all levels of medical care, from primary care to medical specialists.
Access the full text paper at: https://www.ncbi.nlm.nih.gov/pubmed/29374615