Mirna Chehade, MD, MPH1, Lauren Gehman, PhD2, Henrik S. Rasmussen, MD, PhD3
1Icahn School of Medicine at Mount Sinai, New York, NY; 2Allakos, Inc, Redwood City, CA; 3Allakos, Inc., Redwood City, CA
Introduction: Eosinophilic gastritis (EG) and eosinophilic gastroenteritis (EGE) are chronic diseases characterized by elevated eosinophils in gastrointestinal (GI) tract biopsies. Patients with EG and/or EGE (EG/EGE) suffer from a decreased quality of life due to debilitating GI symptoms, a lengthy path to diagnosis, and lack of safe and effective treatment options. Here we utilize a large, highly representative claims database of ~300 million US individuals to characterize the real-world diagnosis and management of adult patients with EG/EGE.
Methods: EG/EGE patients were identified by having ≥1 claim with a diagnosis code for EG and/or EGE (ICD-10-CM code K52.81) from Aug 2008 to Oct 2018 from Symphony Health’s PatientSource® data. This analysis is focused on 3,458 unique adult patients (≥18 years) who had continuous claims data coverage for ≥3 years before and ≥1 year after EG/EGE diagnosis.
Results: Mean time from initial symptom presentation to EG/EGE diagnosis was 46.9 months; factors contributing to delayed diagnosis included delayed gastroenterologist referral, delayed endoscopy (Table 1), failure to diagnose on first endoscopy (39% of patients) and lack of routine biopsy/histopathology (65% of endoscopies). In the 12-month period following EG/EGE diagnosis, a majority of patients (56%) continued to experience GI symptoms, including abdominal pain, diarrhea and vomiting. Symptoms were documented by a healthcare provider at a mean frequency of 3.3 times per year. Overall, 32% of patients were treated with systemic corticosteroids (most commonly prednisone or prednisolone) and 6% received enteric-coated topical steroids (budesonide). Patients treated with systemic corticosteroids received a mean of 3.3 prescriptions per year, with the majority (59%) receiving more than one prescription per year. Persistence of GI symptoms was not related to treatment with systemic corticosteroids (Table 2).
Discussion: Patients with EG/EGE endure a lengthy path to diagnosis, and many continue to experience chronic, persistent GI symptoms after confirmed diagnosis despite frequent treatment with systemic corticosteroids. The lack of standard diagnostic processes and therapeutic options may prolong patient suffering due to uncontrolled symptoms. This study highlights the need for heightened disease awareness, standardized diagnostic criteria, and availability of safe and effective treatment options to improve the care of patients with EG/EGE.
Citation: Mirna Chehade, MD, MPH; Lauren Gehman, PhD; Henrik S. Rasmussen, MD, PhD. P2667 - PATIENTS WITH EOSINOPHILIC GASTRITIS AND/OR EOSINOPHILIC GASTROENTERITIS ENDURE A LENGTHY PATH TO DIAGNOSIS AND EXPERIENCE PERSISTENT SYMPTOMS AFTER DIAGNOSIS. Program No. P2667. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.