Vanderbilt University Medical Center Nashville, TN
Muhammad Hashim Hayat, MBBS, Kevin G. Buell, MBBS, Rishi D. Naik, MD, MS, Michael F. Vaezi, MD, PhD, MS, FACG, Dhyanesh A. Patel, MD, MS; Vanderbilt University Medical Center, Nashville, TN
Introduction: In the last two decades, Eosinophilic esophagitis (EoE) has emerged as a dominant cause of dysphagia in adults. The incidence and prevalence of EoE is rising and the prevalence in adults is currently estimated between 40 to 90 cases per 100,000 people. Clinicopathological guidelines relating to EoE were first published in 2007 which led to increased recognition of the disease as well as diagnosis. We assessed the impact of these changes on the total number of hospital admissions trends and healthcare expenditure by reviewing the nationwide EoE related admissions in the United States over the past eight years. Methods: We reviewed the National Inpatient Sample Database for Emergency Department (ED) Visits and all hospitalizations with a principal discharge diagnosis of EoE (ICD9 code 530.13) between the years 2008–2015. The year 2008 as a start point due to the first consensus clinicopathological diagnostic guidelines for the diagnosis of EoE by the American Gastroenterological Association being published in 2007. 2015 was decided as an endpoint as data for 2016 and beyond is still not fully available. Trends in discharge rates, costs of hospitalization, and length of stay were analyzed. Results: In 2008, the total number of age-sex standardized admissions for EoE was 140 and the total number of ED visits was 178. In 2014, these figures increased to 705 and 1260, respectively. Rate of admissions per 100,000 patients increased from 0.046 in 2008 to 0.249 (p < 0.01) in 2015, a 441.3% increase from baseline. The rate of ED visit per 100,000 patients increased from 0.058 in 2008 to 0.395 in 2014, a 581% increase from baseline. The mean length of stay for admissions increased from 2.59 days in 2008 to 3.57 days in 2015 (p < 0.01). The mean hospital cost associated with EoE admission doubled from $15,775 in 2008 to $30,514 in 2015, after adjusting for inflation. Discussion: The incidence of patients admitted for EoE in the United States and the length of hospital stay significantly increased from 2008 to 2015. Whether this was due to increased recognition or increase in incidence, remains unclear. The cost of hospitalization equally doubled. These trends reflect the improvement in our diagnostic testing for EoE and the need for better treatment and symptom control.
Figure 1: National Diagnoses - ICD-9-CM Code Principal Diagnosis: 530.13, Eosinophilic Esophagitis - All ED Visits
Figure 2: National Diagnoses - ICD-9-CM Code Principal Diagnosis: 530.13, Eosinophilic Esophilic - All Admissions with Standard Errors
Figure 1: National Diagnoses - ICD-9-CM Code Principal Diagnosis: 530.13, Eosinophilic Esophagitis - Charges Per Admission
Disclosures: Muhammad Hashim Hayat indicated no relevant financial relationships. Kevin Buell indicated no relevant financial relationships. Rishi Naik indicated no relevant financial relationships. Michael Vaezi indicated no relevant financial relationships. Dhyanesh Patel indicated no relevant financial relationships.