Multicenter survey on eosinophilic esophagitis in Italy: trends in diagnosis, diagnostic delay, and type 2 comorbidity burden.

Background. Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disorder that has been increasingly recognized over recent decades. It is characterized by a type 2 inflammatory response, shared with other type 2 inflammatory conditions such as allergic rhinitis (AR), food allergy (FA), atopic dermatitis (AD), bronchial asthma (BA), and chronic rhinosinusitis with nasal polyps (CRSwNP). Methods. A total of 295 patients with EoE, followed at seven Italian allergy centers with expertise in managing EoE, were included. We analyzed annual EoE diagnoses, diagnostic delay, and the presence of type 2 comorbidities - including AR, FA, BA, AD and CRSwNP - assessed via allergological evaluations at the participating centers. Statistical analyses included non-parametric trend tests, linear and logistic regressions, chi-square tests, and descriptive analyses. Results. Annual EoE diagnoses showed a significant upward trend from 2014 to 2024 (p = 0.002). However, the diagnostic delay remained consistently high, showing no corresponding reduction despite the rise in diagnoses. The burden of type 2 comorbidities was substantial, with 83.4% of patients presenting at least one comorbidity, and most patients exhibited multiple comorbidities. Conclusions. Our findings are consistent with previously reported increases in EoE diagnoses in Italy, alongside persistent diagnostic delays, and highlight the substantial burden of type 2 comorbidities in these patients, emphasizing the importance of systematic allergological evaluation and multidisciplinary managementin patients with EoE.