Diagnosis of eosinophilic esophagitis in patients with dysphagia during the Coronavirus Disease 2019 (COVID-19) pandemic

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic posed restrictions to many standard practices. Dysphagia is a common presentation of eosinophilic esophagitis (EoE) in adults, and biopsy via esophagogastroduodenoscopy (EGD) is required for diagnosis. We hypothesized that a diagnosis of EoE has declined during the pandemic. Objective: To investigate whether the COVID-19 pandemic influenced the likelihood of an EGD and an EoE diagnosis in patients with dysphagia. Methods: In this retrospective matched cohort study, we used the TriNetX US Collaborative Network to identify adult patients who presented with dysphagia to the emergency department (ED) during the year of and the year preceding the pandemic. Patients with a previous EoE diagnosis were excluded. The two cohorts were balanced for demographics, gastroesophageal reflux disease (GERD) diagnosis, obesity, H2 blockers and proton-pump inhibitors use, anemia, smoking, and alcohol use. The proportion of patients who received an EGD, and an EoE and a GERD diagnosis were contrasted up to 90 days from ED evaluation. Results: We identified 16,942 adult patients during the pandemic, and 16,942 adult patients the year preceding the pandemic who presented to the ED with a concern of dysphagia. During the 30-day follow-up period, no significant difference was observed in the proportion of patients who received an EGD during the pandemic versus the prepandemic period at 1, 7, and 30 days from ED evaluation. The proportion of patients who received an EoE diagnosis was not different, but slightly more patients received a GERD diagnosis during the pandemic versus prepandemic that was evident by day 30 (31.2% versus 30%; p ≤ 0.05). Conclusion: Our results revealed that the COVID-19 pandemic did not significantly impact diagnostic EGD and an EoE diagnosis.