Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis

Berkeley N. Limketkai; Shailja C. Shah; Ikuo Hirano; Emanuelle Bellaguarda; Jean Frederic Colombel

doi:10.1136/gutjnl-2018-318074

Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis

Berkeley N. Limketkai, Shailja C. Shah, Ikuo Hirano, Emanuelle Bellaguarda, Jean Frederic Colombel^*

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

53 Scopus citations

Abstract

Objective Eosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses. Design We conducted a prospective cohort analysis using the Truven MarketScan database (2009-2016) to estimate the incidence and prevalence of EoO in patients with Crohn's disease (CD) or UC and vice versa. Cox proportional hazards and Kaplan-Meier methods were used to estimate the risk of EoO-related or IBD-related complications among patients with concurrent diagnoses. Results Among 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio [IRR] 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01). Conclusion Based on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.

Original language	English (US)
Pages (from-to)	2152-2160
Number of pages	9
Journal	Gut
Volume	68
Issue number	12
DOIs	https://doi.org/10.1136/gutjnl-2018-318074
State	Published - Dec 1 2019

Funding

Competing interests iH received consulting fees and research support from adare, allakos, celgene, regeneron and Shire. J-Fc received research grants from abbvie, Janssen and takeda; received payments for lectures from abbvie, amgen, Ferring, Shire and takeda; received consulting fees from abbvie, amgen, Boehringer ingelheim, celgene, celltrion, enterome, Ferring, genentech, Janssen, eli lilly, Mediummune, Merck, novartis, Pfizer, Protagonist, Sandoz, Second genome, Seres, Shire, takeda, theradiag and theravance; and holds stock options in intestinal Biotech Development and genfit.

Keywords

epidemiology
inflammatory bowel disease
oesophagitis

ASJC Scopus subject areas

Gastroenterology

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10.1136/gutjnl-2018-318074

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@article{c2dd345cd8c74b79853293bc2d051e19,

title = "Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis",

abstract = "Objective Eosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses. Design We conducted a prospective cohort analysis using the Truven MarketScan database (2009-2016) to estimate the incidence and prevalence of EoO in patients with Crohn's disease (CD) or UC and vice versa. Cox proportional hazards and Kaplan-Meier methods were used to estimate the risk of EoO-related or IBD-related complications among patients with concurrent diagnoses. Results Among 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio [IRR] 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01). Conclusion Based on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.",

keywords = "epidemiology, inflammatory bowel disease, oesophagitis",

author = "Limketkai, {Berkeley N.} and Shah, {Shailja C.} and Ikuo Hirano and Emanuelle Bellaguarda and Colombel, {Jean Frederic}",

note = "Funding Information: Competing interests iH received consulting fees and research support from adare, allakos, celgene, regeneron and Shire. J-Fc received research grants from abbvie, Janssen and takeda; received payments for lectures from abbvie, amgen, Ferring, Shire and takeda; received consulting fees from abbvie, amgen, Boehringer ingelheim, celgene, celltrion, enterome, Ferring, genentech, Janssen, eli lilly, Mediummune, Merck, novartis, Pfizer, Protagonist, Sandoz, Second genome, Seres, Shire, takeda, theradiag and theravance; and holds stock options in intestinal Biotech Development and genfit. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2019",

month = dec,

day = "1",

doi = "10.1136/gutjnl-2018-318074",

language = "English (US)",

volume = "68",

pages = "2152--2160",

journal = "Gut",

issn = "0017-5749",

publisher = "BMJ Publishing Group",

number = "12",

}

TY - JOUR

T1 - Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis

AU - Limketkai, Berkeley N.

AU - Shah, Shailja C.

AU - Hirano, Ikuo

AU - Bellaguarda, Emanuelle

AU - Colombel, Jean Frederic

N1 - Funding Information: Competing interests iH received consulting fees and research support from adare, allakos, celgene, regeneron and Shire. J-Fc received research grants from abbvie, Janssen and takeda; received payments for lectures from abbvie, amgen, Ferring, Shire and takeda; received consulting fees from abbvie, amgen, Boehringer ingelheim, celgene, celltrion, enterome, Ferring, genentech, Janssen, eli lilly, Mediummune, Merck, novartis, Pfizer, Protagonist, Sandoz, Second genome, Seres, Shire, takeda, theradiag and theravance; and holds stock options in intestinal Biotech Development and genfit. Publisher Copyright: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Objective Eosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses. Design We conducted a prospective cohort analysis using the Truven MarketScan database (2009-2016) to estimate the incidence and prevalence of EoO in patients with Crohn's disease (CD) or UC and vice versa. Cox proportional hazards and Kaplan-Meier methods were used to estimate the risk of EoO-related or IBD-related complications among patients with concurrent diagnoses. Results Among 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio [IRR] 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01). Conclusion Based on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.

AB - Objective Eosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses. Design We conducted a prospective cohort analysis using the Truven MarketScan database (2009-2016) to estimate the incidence and prevalence of EoO in patients with Crohn's disease (CD) or UC and vice versa. Cox proportional hazards and Kaplan-Meier methods were used to estimate the risk of EoO-related or IBD-related complications among patients with concurrent diagnoses. Results Among 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio [IRR] 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01). Conclusion Based on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.

KW - epidemiology

KW - inflammatory bowel disease

KW - oesophagitis

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U2 - 10.1136/gutjnl-2018-318074

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SN - 0017-5749

VL - 68

SP - 2152

EP - 2160

JO - Gut

JF - Gut

IS - 12

ER -

Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis

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