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

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.