Time Trends and Impact on Treatment Outcomes of Psychiatric Diagnoses in Patients with Eosinophilic Esophagitis

Alexandra A. Weir; Stefani Aleman; Sean S. LaFata; Timothy S. Gee; Angelica R. Lackey; Arjun K. Juneja; Hannah L. Thel; Brenderia A. Cameron; Justin McCallen; Christopher J. Lee; Gustaf N. Hendrick; Jose C. Bermudez; Daniel Song; Trevor S. Barlowe; Walker D. Redd; Cary C Cotton; Craig C. Reed; Evan S. Dellon

doi:10.15403/jgld-7110

Authors

Alexandra A. Weir Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Stefani Aleman Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Sean S. LaFata Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Timothy S. Gee Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Angelica R. Lackey Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Arjun K. Juneja Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Hannah L. Thel Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Brenderia A. Cameron Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Justin McCallen Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Christopher J. Lee Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Gustaf N. Hendrick Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Jose C. Bermudez Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Daniel Song
Trevor S. Barlowe Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Walker D. Redd Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Cary C Cotton Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Craig C. Reed Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Evan S. Dellon Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC, USA

DOI:

https://doi.org/10.15403/jgld-7110

Keywords:

EoE, eosinophilic esophagitis, mental health, topical steroids, diet elimination

Abstract

Background and Aims: While mental illness is common in eosinophilic esophagitis (EoE), it is unknown whether psychiatric diagnosis frequency has varied over time or impacts treatment outcomes. We aimed to determine time trends in psychiatric diagnoses in EoE and whether such diagnoses affect EoE treatment outcomes.

Methods: In this retrospective cohort study of newly diagnosed EoE patients, medical records were examined to determine psychiatric diagnoses and psychoactive medication use. For patients who also had treatment with either a topical corticosteroid (tCS) or diet elimination and had a follow-up endoscopy with biopsy, histologic, endoscopic, and symptom responses were assessed. We evaluated time-trends in psychiatric diagnoses over >2 decades and compared tCS and diet elimination treatment response between patients with and without psychiatric diagnoses.

Results: Of 1291 newly diagnosed patients with EoE, 29% had a concomitant psychiatric diagnosis (18% depression; 24% anxiety) and 25% were on psychiatric medications. Over the 2-decade study timeframe, there was a slight overall increase in psychiatric diagnoses. However, diagnoses spiked in 2020 to >50% during the coronavirus disease 2019 (COVID-19) pandemic. There was no worsening in response rates for those with psychiatric diagnoses for either tCS or diet elimination treatment.

Conclusions: Psychiatric diagnoses demonstrate a slight increase in EoE over the past 2 decades, though rates spiked during the COVID-19 pandemic, substantiating the burden of depression and anxiety during this time. Interestingly, the presence of a psychiatric disorder did not impact treatment outcomes to either tCS or diet elimination, so either option is viable in EoE patients with these diagnoses.