Psychiatric Comorbidities and Psychiatric Medication Use Are Highly Prevalent in Patients With Eosinophilic Esophagitis and Associate With Clinical Presentation

Abstract

OBJECTIVES: The prevalence of psychiatric disease in patients with eosinophilic esophagitis (EoE) is not fully characterized. We aimed to determine the prevalence of psychiatric disease and centrally acting medication use in a cohort of children and adults with EoE and evaluated whether psychiatric disease affects the EoE clinical presentation. METHODS: We conducted a retrospective study of newly diagnosed cases with EoE at the University of North Carolina from 2002 to 2018. Psychiatric comorbidities and relevant treatments were extracted from the medical records. The demographic and clinical features of patients with EoE with and without psychiatric diagnoses, and those with and without psychiatric medication use, were compared. RESULTS: Of 883 patients (mean age 26.6 years, 68% men, 79% white), 241 (28%) had a psychiatric comorbidity. The most common diagnosis was anxiety (23%) followed by depression (17%); 28% of patients were treated pharmacologically. There were 45 patients (5%) treated pharmacologically without a psychiatric diagnosis for chronic pain syndromes, insomnia, and/or epilepsy. Cases with EoE with a psychiatric diagnosis were more likely to be women, white, and 18 years or older and to have a longer symptom duration before diagnosis. DICUSSION: Psychiatric comorbidities were common in EoE, seen in a third of adults and more than 1 in 7 children, and with similar proportions receiving a prescription medication. These illnesses affected the EoE presentation because psychiatric comorbidities were more likely in older, female, and white patients with a longer duration of symptoms preceding diagnosis.

Unlocking the Mind Might Be Critical in Management of Eosinophilic Esophagitis: Expanding Beyond Drugs, Dilation, and Diet

“…This study reinforces findings of prior studies that show psychiatric comorbidities are common in patients with EoE. 9,10 In a cohort of 883 patients with EoE, up to 1 in 3 adults and more than 1 in 7 children had psychiatric comorbidities, with anxiety being the most common diagnosis. 9 Although the study highlights potential role of anxiety and hypervigilance in symptom generation, it has significant limitations.…”

“…9,10 In a cohort of 883 patients with EoE, up to 1 in 3 adults and more than 1 in 7 children had psychiatric comorbidities, with anxiety being the most common diagnosis. 9 Although the study highlights potential role of anxiety and hypervigilance in symptom generation, it has significant limitations. Questionnaires were given immediately before endoscopy, and there are no longitudinal data available to compare the effect of waiting for the procedure itself.…”

Esophageal Hypervigilance and Symptom-Specific Anxiety in Patients with Eosinophilic Esophagitis

“…Moreover, 36% of the sample scored above the 80 th percentile on the Symptom Checklist-90-Revised Global Severity Index, which measures multiple mental health domains, including anxiety, phobic anxiety, and obsessive-compulsive behaviors. 33 A retrospective review in the same year found identical rates of anxiety as measured by the HADS (23%) in 883 patients with EoE, 34 suggesting anxiety is an important mental health consideration in this population. Comparatively, a 2019 retrospective chart review identified only 9.3% of 34 patients had an International Classification of Diseases, Ninth Revision 35 or International Classification of Diseases, Tenth Revision 36 diagnosis of an anxiety disorder.…”

Mental distress among adult patients with eosinophilic esophagitis

“…Multiple aspects such as disturbing symptoms of dysphagia and food impaction and the need for life‐long treatment are associated with impaired HRQOL 5‐7 . A recent medical record review observed a prevalence of psychiatric health comorbidities in almost one‐third of EoE patients, in which older age, female gender, and longer symptom duration were found to be associated with the presence of a mental health disorder 8 . Current research has mainly focused on increased risk of developing anxiety and depressive symptoms, measured within the construct of disease specific HRQOL (EoE‐QOL‐A) 7,9,10 .…”

“… 5 , 6 , 7 A recent medical record review observed a prevalence of psychiatric health comorbidities in almost one‐third of EoE patients, in which older age, female gender, and longer symptom duration were found to be associated with the presence of a mental health disorder. 8 Current research has mainly focused on increased risk of developing anxiety and depressive symptoms, measured within the construct of disease specific HRQOL (EoE‐QOL‐A). 7 , 9 , 10 This validated measure consists of 5 domains that evaluates important disease‐related topics (e.g., issues related to having a chronic disease or swallowing anxiety) and has been widely used in the EoE‐research field.…”