The Effects of Patient Demographics on Outpatient Endoscopy Utilization in Children with Eosinophilic Esophagitis.

OBJECTIVES Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that requires esophagogastroduodenoscopy (EGD) for diagnosis and treatment monitoring. We aimed to identify frequency of endoscopic monitoring in children with EoE and observe the effect of age, race, socioeconomic factors, and atopy on the rate of endoscopy. METHODS We queried the Pediatric Health Information System over a 15-year period for ambulatory EGDs in children with EoE. Subjects with at least 1 year of data were included. Age, gender, ethnicity, race, insurance type, median household income, and atopy were collected for each subject. RESULTS 16,517 subjects were included (mean age 8.5y). 3,211 (19%) of subjects had ≥ 1 EGD per subject year (EGD/SY). Subjects > 13 years old were more likely to have ≥ 1 EGD/SY compared to children 6-12 years (OR 2.29, p < 0.001, 95%CI = 2.06-2.54). Males were more likely to have ≥ 1 EGD/SY compared to females (OR 1.18, p < 0.001, 95%CI = 1.08-1.31). African-American subjects were 16% less likely than Caucasian subjects to have ≥ 1 EGD/SY (OR 0.84, p = 0.05, 95%CI = 0.71-1.00). Subjects with allergic rhinitis or anaphylaxis, food allergy, and/or oral allergy syndrome were more likely to have ≥ 1 EGD/SY (OR 1.67, p < 0.001, 95%CI = 1.47-1.90 and OR 3.65, p < 0.001, 95%CI = 3.25-4.11 respectively). CONCLUSIONS 19% of subjects had ≥ 1 EGD/SY. Older age, male gender, allergic rhinitis, and food allergies were associated with more frequent endoscopic monitoring in children with EoE. Caucasian subjects had more frequent endoscopy than African-American subjects. This study raises awareness about underrecognized variation in the care of children with EoE.