Eosinophilic Oesophagitis (EOE), is an allergic inflammation of the oesophagus or gullet most commonly seen in young,white men,especially those with allergic diseases like asthma and eczema. EOE causes swallowing difficulty and people often present to hospitals with food stuck in the oesophagus. Severe untreated cases of EOE can lead to narrowing of the oesophagus, requiring stretching or dilatation procedures . Early recognition and treatment can prevent these outcomes and improve the quality of life for patients.
The study aims are to see how common EOE is and if this is changing.To see why people with EOE see their GPs and hospitals. To see if there are significant delays in diagnosis resulting in emergency visits to hospital.
An observational study using CPRD Aurum linked Hospital Episode statistics data will be undertaken. Adults aged 18 year and above, registered with a primary care practice for at least one year before the index date will be included.
Part 1
The annual incidence rates of eosinophilic oesophagitis (EoE) from 1995 to 2020 will be examined by performing yearly cohort studies. Cross sectional studies will be undertaken to examine the prevalence of EoE from 2010 to 2020.
Part 2
Patients will be followed retrospectively from EoE diagnosis date to first presentation with symptoms potentially related to EoE in primary or secondary care (index date). Patients with an incident diagnosis of EoE identified through SNOMED CT codes in CPRD Aurum will be included. The primary outcome is a description of the variation in the time from index date to EoE diagnosis. We will examine the number of emergency and other secondary care attendances prior to EoE diagnosis with linked HES APC data to look for potentially missed opportunities to diagnose EoE.
Part 3
All patients under the age of 50 presenting to primary care with dysphagia or food bolus obstruction identified through SNOMED CT codes will be included. Primary care management of such symptoms will be examined in a descriptive study including referral rates for OGD, biopsy and the prescription of proton pump inhibitors (PPI) prior to investigation. We will assess the association of presenting to primary care with dysphagia and food bolus obstruction and secondly being referred for endoscopy with a number of variables using multivariable logistic regression models.
By examining the time to diagnosis and its impact on patients and their management with EoE, we will be able to assess whether there is a need for active case finding and guide referral pathway redesign to facilitate prompt diagnosis and management.
Incidence and prevalence of EOE in primary care ; Admission to accident and emergency with dysphagia; Hospital attendance for endoscopy ; diagnostic delays of EOE.
Nicola Adderley - Chief Investigator - University of Birmingham
Nosheen Umar - Corresponding Applicant - University of Birmingham
Joht Singh Chandan - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Nicola Adderley - Collaborator - University of Birmingham
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Townsend Index