The incidence of eosinophilic oesophagitis in 2007-2017 among children in North Denmark Region is lower than expected

BACKGROUND: In North Denmark Region (NDR), the incidence of Eosinophilic Oesophagitis (EoE) among adults has increased following a new biopsy protocol in 2011, whereas data on the incidence of EoE among children is lacking. AIMS: To describe the incidence of EoE in children aged 0–17 in NDR as well as diagnostic delay, clinical manifestations, treatment and complications. METHODS: This retrospective, register-based DanEoE cohort study included 18 children diagnosed with EoE between 2007–2017 in NDR. Medical files were reviewed with attention to symptoms, reason for referral, disease progress, treatment, symptomatic and histological remission as well as diagnostic delay. RESULTS: The median incidence per year (2007–2017) was 0.86/100,000 children in NDR aged 0–17 years. The median diagnostic delay among children was four years and six months. Sixty percent presented with food impaction at first hospital visit. After initial treatment, only one of 18 children achieved symptomatic and histologic remission and had a long-term treatment plan. CONCLUSIONS: The calculated incidence among children was lower compared to similar studies. Combined with poor remission rates and lack of follow-up, it is likely that EoE is an underdiagnosed and insufficiently treated disease among children in NDR. Our findings suggest that more knowledge concerning EoE in children could lead to a higher incidence, shorter diagnostic delay and more effective treatment

A retrospective cohort study on oesophageal food bolus obstruction in the North Denmark region in 2021-two thirds were never diagnosed with a cause

BACKGROUND: Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3).AIMS: The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR.METHODS: Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded.RESULTS: The median patient age was 66.0 (Q1-Q3: 49.8-81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes.CONCLUSIONS: Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.</p

There is a long way from current clinical practice in Denmark compared to recent published English guideline on management of children with eosinophilic oesophagitis

Background: A low incidence of eosinophilic esophagitis (EoE) in children in the North Denmark Region (NDR) were measured in 2007-2017. Few of the children diagnosed before 2017 were treated to remission suggesting a lack of awareness. While there currently are no guidelines for treating EoE in Denmark, a new English guideline was published in 2022 renewing focus on the disease.Objective: The aim of this study was to measure the difference of current Danish clinical practice for treatment and follow-up of EoE children in the NDR with the new English guideline from the British Society of Gastroenterology (BSG) and the British Society of Pediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN).Methods: This retrospective, register-based DanEoE cohort study included 31 children diagnosed with EoE between 2007 and 2021 in NDR. Medical records were reviewed and information about treatment and follow-up were collected.Results: In 32% of the children with EoE in the NDR, first-line treatment corresponded with the new English guideline. One in 6 children were never started on any treatment even though treatment always is recommended. Histologic evaluation within 12 weeks as recommended was performed in 13% of the children.Conclusions: In Denmark focus on improving EoE treatment and follow-up for children is needed, as there is a significant difference between current clinical practice and the recommendations in the new English guideline

Additional file 1 of There is a long way from current clinical practice in Denmark compared to recent published English guideline on management of children with eosinophilic oesophagitis

Supplementary Material

Devrions-nous manger plus de céréales complètes ?

National audienceWhole grains are sources of dietary fibre but also of vitamins, minerals and antioxidant compounds. Their consumption is associated to health benefits. They decrease type 2 diabetes, cardiovascular diseases and colorectal cancer. ANSES recommends an increase in the consumption of whole cereals which is very low in France; other countries have a recommendation such as 90 g or three servings of whole grains per day. At the same time, ANSES recommends a dietary fibre intake of 30 g per day that cannot be achieved without the consumption of whole grain products. Depending on how they are grown, it can be assumed that whole grains contain more contaminants (including pesticides and mycotoxins) than refined cereal products. The presence of these contaminants is strictly controlled and the levels reached in the foods analyzed do not exceed the Toxicological Reference Values for a vast majority of consumers. Most epidemiological studies demonstrate a positive benefit/risk ratio that confirms the value of consuming whole grains for health.Les céréales complètes sont des sources de fibres alimentaires mais également de vitamines, de minéraux et de composés antioxydants. Leur consommation est associée à des bénéfices pour la santé. Elles diminuent en particulier le risque de diabète de type 2, de maladies cardiovasculaires et de cancer colorectal. L’Anses recommande une augmentation de la consommation de céréales complètes qui est très faible en France ; d’autres pays ont une recommandation chiffrée comme 90g ou trois portions par jour de céréales complètes. En parallèle, l’Anses recommande une consommation de fibres alimentaires de 30g de fibres par jour qui ne peut être atteinte sans la consommation de produits céréaliers complets. Selon leur mode de culture, on peut supposer que les céréales complètes contiennent plus de contaminants (dont pesticides et mycotoxines) que les produits céréaliers raffinés. La présence de ces contaminants est rigoureusement contrôlée et les teneurs atteintes dans les aliments analysés ne dépassent pas les valeurs toxicologiques de référence pour la grande majorité des consommateurs. Les études épidémiologiques démontrent dans leur très grande majorité un ratio bénéfice/risque positif qui confirme l’intérêt de la consommation de céréales complètes pour la santé