Alimentary Pharmacology and Therapeutics Letters to the Editors being used in only 22%. It is now well established that topical steroids are at least, if not more, effective as systemic steroids but without the side effects. For a chronic condition that might require years of therapy, I would strongly advise against systemic steroid use. Is there a reason for such high systemic steroid use in Denmark, and is it possible for the authors to influence future prescribing patterns? It is over 25 years since the condition was first publicised3–5 and, following a period of being regarded as a rare disease, eosinophilic oesophagitis may now be regarded as the second most common disease in the oesophagus. It is now essential that all gastroenterologists and ear nose and throat surgeons are aware of the condition, and know how to diagnose and treat it.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None.
Letter: increasing incidence and prevalence of eosinophilic oesophagitis – author’s reply E. S. Dellon*,† *Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC, USA. † Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. E-mail: [email protected]
REFERENCES 1. Dellon ES, Erichsen R, Baron JA, et al. The increasing incidence and prevalence of eosinophilic oesophagitis outpaces changes in endoscopic and biopsy practice: national population-based estimates from Denmark. Aliment Pharmacol Ther 2015; 41: 662–70. 2. Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 2003; 125: 1660–9. 3. Attwood SEA, Smryk TC, DeMeester TR. Oesophageal asthma: episodic dysphagia with eosinophilic infiltrates. Gut 1989; 30: A1493. 4. Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophagealeosinophilia with dysphagia: a distinct clinicopathologic syndrome. Dig Dis Sci 1993; 38: 109–16. 5. Straumann A, Spichtin HP, Bernoulli R, Loosli J, V€ ogtlin J. Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings. Schweiz Med Wochenschr 1994; 124: 1419–2.
effective in the short term, these agents should be reserved for patients who require rapid improvement in symptoms.4 In our study, while it is correct that 29% of adults with EoE received systemic steroids at some point during the study time frame, we did not examine the specific indication for their use, or the length of the course prescribed. While these medications could have been used for EoE, they also could have been used for any other indication. Further studies would be required to fully examine the extent to which systemic steroids are being used for EoE.
doi:10.1111/apt.13233
SIRS, We thank Dr Attwood for the interest in our recent paper,1, 2 and appreciate his thoughts about the importance for practitioners to be aware of eosinophilic oesophagitis (EoE). We do not have a definitive explanation for the relatively low rate of asthma in the EoE subjects in the Denmark health registries, and agree that the prevalence of asthma and other atopic disorders is typically reported to be higher in patients with EoE than we found in this study.3 However, because our asthma definition used selected ICD-10 codes (J45.0, J45.1, J45.8 and J45.9, as noted in Table S2) and not medical record validation of this condition, it is possible that not all cases of asthma were identified. We agree with Dr Attwood that chronic use of systemic steroids should be avoided in EoE, and recent guidelines highlight that while these are potentially Aliment Pharmacol Ther 2015; 42: 121–129 ª 2015 John Wiley & Sons Ltd
ACKNOWLEDGEMENTS The author’s declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Attwood S. Letter: increasing incidence and prevalence of eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 42: 124–5. 2. Dellon ES, Erichsen R, Baron JA, et al. The increasing incidence and prevalence of eosinophilic oesophagitis outpaces changes in endoscopic and biopsy practice: national population-based estimates from Denmark. Aliment Pharmacol Ther 2015; 41: 662–70. 3. Dellon ES, Liacouras CA. Advances in clinical management of eosinophilic esophagitis. Gastroenterology 2014; 147: 1238–54. 4. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras C, Katzka DA. ACG Clinical Guideline: evidence based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis. Am J Gastroenterol 2013; 108: 679–92.
125
ACKNOWLEDGEMENT Declaration of personal and funding interests: None.
Letter: increasing incidence and prevalence of eosinophilic oesophagitis – author’s reply E. S. Dellon*,† *Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC, USA. † Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. E-mail: [email protected]
REFERENCES 1. Dellon ES, Erichsen R, Baron JA, et al. The increasing incidence and prevalence of eosinophilic oesophagitis outpaces changes in endoscopic and biopsy practice: national population-based estimates from Denmark. Aliment Pharmacol Ther 2015; 41: 662–70. 2. Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 2003; 125: 1660–9. 3. Attwood SEA, Smryk TC, DeMeester TR. Oesophageal asthma: episodic dysphagia with eosinophilic infiltrates. Gut 1989; 30: A1493. 4. Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophagealeosinophilia with dysphagia: a distinct clinicopathologic syndrome. Dig Dis Sci 1993; 38: 109–16. 5. Straumann A, Spichtin HP, Bernoulli R, Loosli J, V€ ogtlin J. Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings. Schweiz Med Wochenschr 1994; 124: 1419–2.
effective in the short term, these agents should be reserved for patients who require rapid improvement in symptoms.4 In our study, while it is correct that 29% of adults with EoE received systemic steroids at some point during the study time frame, we did not examine the specific indication for their use, or the length of the course prescribed. While these medications could have been used for EoE, they also could have been used for any other indication. Further studies would be required to fully examine the extent to which systemic steroids are being used for EoE.
doi:10.1111/apt.13233
SIRS, We thank Dr Attwood for the interest in our recent paper,1, 2 and appreciate his thoughts about the importance for practitioners to be aware of eosinophilic oesophagitis (EoE). We do not have a definitive explanation for the relatively low rate of asthma in the EoE subjects in the Denmark health registries, and agree that the prevalence of asthma and other atopic disorders is typically reported to be higher in patients with EoE than we found in this study.3 However, because our asthma definition used selected ICD-10 codes (J45.0, J45.1, J45.8 and J45.9, as noted in Table S2) and not medical record validation of this condition, it is possible that not all cases of asthma were identified. We agree with Dr Attwood that chronic use of systemic steroids should be avoided in EoE, and recent guidelines highlight that while these are potentially Aliment Pharmacol Ther 2015; 42: 121–129 ª 2015 John Wiley & Sons Ltd
ACKNOWLEDGEMENTS The author’s declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Attwood S. Letter: increasing incidence and prevalence of eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 42: 124–5. 2. Dellon ES, Erichsen R, Baron JA, et al. The increasing incidence and prevalence of eosinophilic oesophagitis outpaces changes in endoscopic and biopsy practice: national population-based estimates from Denmark. Aliment Pharmacol Ther 2015; 41: 662–70. 3. Dellon ES, Liacouras CA. Advances in clinical management of eosinophilic esophagitis. Gastroenterology 2014; 147: 1238–54. 4. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras C, Katzka DA. ACG Clinical Guideline: evidence based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis. Am J Gastroenterol 2013; 108: 679–92.
125
