Matthew Greenhawt, MD | Image credit: Children's Hospital Colorado

Background

According to data from a retrospective, observational study, both incidence and prevalence of eosinophilic esophagitis (EoE) are higher than previously reported. This data was presented at the 2025 American Academy of Allergy Asthma & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress meeting. The meeting is taking place from February 28 through March 3, 2025, in San Diego, California.^1,2

Matthew Greenhawt, MD, of Children’s Hospital Colorado, and lead clinical trial investigator of the EoE prevalence study, details the study and its findings in the Q+A interview below. Data points from the trial were featured in a poster presentation on February 28, 2025, at the AAAAI / WAO meeting.

The study authors, according to an abstract published in the Journal of Allergy and Clinical Immunology, examined health insurance claims in the United States using claims data from the MarketScan database. Read below for full study details and results, as explained by Greenhawt.³

In addition, Greenhawt commented on the updated American College of Gastroenterology (ACG) guideline for diagnosis and management of EoE.⁴

Q+A transcription

Contemporary Pediatrics:

Can you explain your rationale behind the poster presentation featured at the 2025 AAAAI / WAO meeting, titled “High Incidence and Prevalence of Eosinophilic Esophagitis in the USA Identified: An Analysis of US Health Insurance Claims Data?”

Matthew Greenhawt, MD:

The rationale was to use claims data to update the estimated incidence and prevalence of EoE in the United States. Claims data has the advantage of looking at actual payment for the diagnosis (as opposed to looking at codes for a claim), and represents what is being spent. The dataset we used was the MarketScan database over a 3-year study period from July 1, 2020, to June 30, 2023.¹

Consistent with multiple other studies, these claims data show an increasing incidence and prevalence of EoE from 2020-2023 compared to previous estimates, and confirms that this is a far more common diagnoses than we once suspected.

Using data from patients with 1 or more inpatient or outpatient insurance claims for EoE, the estimated US incidence of EoE was 0.06% and the estimated prevalence was 0.15%, and for patients with 2 or more insurance claims, the estimated US incidence of EoE was 0.03% and the estimated prevalence was 0.08%.

The incidence and prevalence of EoE were higher in patients aged 18 to 64 years than in those aged up to 17 years and those aged more than 65 years. Trends were similar between analyses using data from patients with 1 or more, and 2 or more insurance claims; however, the prevalence and incidence estimates were lower when using data from patients with 2 or more insurance claims.

The incidence and prevalence were higher in male than in female patients and were higher in commercially insured patients than in those with Medicare or Medicaid.¹

Contemporary Pediatrics:

What do these overall findings mean for EoE care, patient care and what are takeaways for health care overall, as related to EoE?

Greenhawt:

This means a few things. First, this is not a rare disease, and both the incidence and prevalence are steadily increasing. Second, while this affects patients of all races, incomes, insurances, and both males and females, there are a few disparities that are important to consider.

Claims for EoE were more prevalent among patients 18-64 years, among males compared to females, and claims for this were less common with Medicare and Medicaid insured patients. It is unclear if the insurance trends indicate that this is under-diagnosed among Medicare and Medicaid.¹

Contemporary Pediatrics:

Is there anything specifically you would like to highlight for general providers, related to this increase in prevalence or otherwise?

Greenhawt:

It is important to have a good index of suspicion for this diagnosis, especially among atopic individuals with a history of recurrent reflux, dysphagia, or food impaction/near impaction.

EoE is a lot more common than presumed and can hide in plain sight as patients often underreport symptoms or accommodate them and may not highlight these as being abnormal.¹

Contemporary Pediatrics:

Can you comment or point out any key highlights from the updated clinical guideline released by the American College of Gastroenterology, and discuss what the biggest takeaways are?

Greenhawt:

These recent guidelines from the ACG reinforce earlier guidelines from 2020 by the American Gastroenterological Association, AAAAI, and American College of Allergy Asthma and Immunology, emphasizing the strongest recommendations and highest quality of evidence for the use of topical swallowed steroids.

Given data for dupilumab are now available, there is an updated conditional recommendation with moderate quality of evidence in favor of its use, which represents something new from past guidelines. The number of conditional recommendations should underscore that EoE is a preference-sensitive condition, with a number of management options that can help, with the best choice likely dependent on the patient’s values and preferences for specific features of treatment.²

References:

1. Greenhawt M, Bansal P, Goodwin B, et al. High incidence and prevalence of eosinophilic esophagitis in the USA identified: An analysis of US health insurance claims data. Poster. Presented at: 2025 American Academy of Allergy Asthma & Immunology and World Allergy Organization Joint Congres. February 28 - March 3, 2025. San Diego, California.

2. General information. AAAAI/WAO. Accessed February 28, 2025. https://annualmeeting.aaaai.org/attendee/general-information

3. Greenhawt M, Bansal P, Goodwin B, et al. High incidence and prevalence of eosinophilic esophagitis in the USA identified: An analysis of US health insurance claims data. Abstract. Accessed February 28, 2025. J Allergy Clin Immunol. https://www.jacionline.org/pb-assets/Health%20Advance/journals/ymai/AAAAI_2025_February28-1738868845313.pdf

4. Dellon E, Muir A, Katzka D, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. The American Journal of Gastroenterology. January 2025. doi: 10.14309/ajg.0000000000003194