Comparison of Clinical Profile and Treatment Outcomes of Eosinophilic Esophagitis Patients in Community Versus Tertiary Care Hospital: A Prospective, Multicentre Study

Aims Eosinophilic esophagitis (EoE) is showing a skyrocketing increase of new diagnoses in last two decades. Most of the evidences come from high volume–referral centres that may be not representative of the whole EoE population. In fact, little is known about demographic and clinical features as well as treatment outcomes of patients managed in community hospitals. The main goals of our study were to compare the cohorts of EoE patients from a community and a tertiary care centre in terms of demographic and clinical features as well as to assess differences in the rate of response to medical treatments.

Methods Between January 2021 and June 2023, we prospectively enrolled all EoE patients evaluated for the first time at two different centres: 1) a high-volume tertiary-care centre, the University Hospital of Padua (PH), that represent a national referral centre; 2) a low-volume community hospital, the hospital of Feltre (FH), with a catchment area of about 25,000 people, both located in the North-East of Italy. The diagnosis of EoE was made according to the latest international guidelines. Endoscopic features were assessed according to EREFS score (0-8 points). Histological remission was considered for eosinophilic peak<15 eos/HPF.

Results We consecutively enrolled 210 patients, 177 (84.3%) PH and 33 (15.7%) in FH. We did not find any significant difference between the two cohorts regarding age (34.80 vs 38.24, p=0.193), male prevalence (79.1 vs 72.7%, p=0.491), body mass index (22.55 vs 22.63, p=0.906), prevalence of non-atopic comorbidities (35.6% vs 21.2%, p=0.158), diagnostic delay (3.35 vs 2.62 years, p=0.682). A not significant trend in higher EREFS score values was found in PH (3.3 vs 2.7, p=0.062). There was a significant difference regarding the number of patients evaluated for a second opinion (77% vs 15%, p<0.001) and prevalence of atopic comorbidities (68.9% vs 42.4%, p=0.008), both higher in PH court.

Regarding medical treatments 184 patients were treated with PPI (157, 88.7% at PH and 27, 81.8% at FH, p=0.219). There was a significant difference comparing PH and FH patients in the rate of PPI histological response (29.94% vs. 51.85%, p=0.044) and clinical response (60.5% in PH vs 92.6% in FH, p<0.001). No differences in terms of rate of histological responsiveness regarding flixotide (44% vs 36%, p=0.295) and budesonide (50.9% vs 61.5%, p=0.564). No differences were found regarding clinical response to flixotide (67.1% vs 88.8%, p=0.266) and budesonide (60.3% vs 76.9%, p=0.368).

Conclusions This study elucidated several significant aspects regarding EoE. It revealed that EoE patients treated in peripheral hospitals may exhibit a milder phenotype, with less severe endoscopic features and fewer atopic comorbidities. Conversely, more complex cases tend to be referred to specialised centres for a second opinion. The rate of PPIs clinical and histological responsiveness was higher in community hospitals so they still hold a significant as effective therapy Most of the evidence come from high-volume referral centres, it is crucial to keep in mind these differences when assessing the wide spectrum of EoE patients.

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Artikel online veröffentlicht:
27. März 2025