indicator area over the last 21 years. Methods: Olten County is an area of approximately90,000 inhabitants without pronounced demographic changes during the last two decades.Two EoE-experienced gastroenterologists and one pathology centre are responsible forcovering the gastroenterological service of the area. No public programs for increasingawareness of EoE were implemented in this region. Since 1989 all individuals with confirmeddiagnosis of EoE living in Olten County were entered prospectively into the database. Results:Forty-six patients (76% males, mean age 41±16 yrs) were diagnosed with EoE between1989 and 2009. Ninety-four percent of patients presented with dysphagia. An average annualincidence rate of 1.88/100,000 was found (range 0-8) with a marked increase in the periodfrom 2004 to 2009. The cumulative EoE prevalence rose up to 35.1/100,000 inhabitantsin 2009. No significant change was observed for the median diagnostic delay, as it was 3years from 1989 to 1998 and 2 years from 1999 to 2009 with age < 40 years representinga risk factor for retarded diagnosis. The number of upper endoscopies per year increasedby 63% in the period from 1999 to 2009 compared to the years 1989 to 1998 which ismarkedly less then the increase in the incidence rate of 150% for the same periods. Conclu-sions: Over the last 21 years, a significant increase in EoE incidence and prevalence wasfound in an epidemiologically stable indicator region of Switzerland. The constant diagnosticdelay, the number of newly diagnosed EoE cases that was much more pronounced thanthe modest increase of performed upper endoscopies, as well as the lack of EoE awarenessprograms in Olten County indicates a true increase in EoE incidence.

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Effect of Parental Stress on Management of Childhood EGIDSarah Ballou, Tiffany Taft, Laurie Keefer

Background: Eosinophilic Disorders (EGIDs) are chronic inflammatory diseases of the digest-ive tract that are associated with intensive treatment and poor health outcomes. EGIDsdiagnosed in children require extensive parent involvement in disease management. Previousresearch on parental-caregiver stress (PCS) suggests that parents of children with chronicillnesses may report increased psychological distress, increased child health-care utilization(HCU), and decreased quality of life. PCS in EGIDs has not been studied empirically. Thisstudy aims to evaluate the relationship between PCS, child illness severity, and resultingHCU. Methods: Parents of children with EGIDs were recruited via advertisement to disease-specific support groups. Eligible participants completed a web-based survey which included:Pediatric Inventory for Parents (PIP) a measure of frequency and difficulty with PCS, demo-graphics, child's symptom frequency, # of food allergies, treatments, and HCU. Separatestepwise linear regression and Factorial ANOVA assessed the relationship between PCS,child clinical data and HCU. Results: 175 parents participated. 98% were female/child'smother, (mean±SD) 38.5±7.1 yrs old, 93% Caucasian, 47% suburban dwellers, and 89%married. Children with EGIDs were 7.9±5.0 yrs old, 72% male, and had 13.6±7.5 foodallergies. 45% have daily Sxs, 86% were on a restricted diet, 64% on 1-3 daily medications,and 72% had active disease. Mean time since Dx was 6.2±4.0 years. Stepwise regressionshowed that frequent PCS significantly predicts 27.4% of the variance in number of MDappts, 7% in the number of ER visits, and 8% in number of procedures. Frequent PCSrelated to interactions with medical providers and poorer emotional functioning significantlypredicted increased MD visits, while communication challenges with family/friends predictedmore ER visits and procedures. Flare frequency significantly predicted increased MD andER visits. However when combined with frequency of PCS, flare frequency no longersignificantly predicts increased HCU. All other clinical variables were not significant pre-dictors. Factorial ANOVA revealed that only parents with 10 or more MD appts/yr reportedsignificantly increased PCS frequency scores. All other differences were non-significant.Conclusions: Our preliminary study of the relationship between PCS and HCU demonstratedthat frequency of parenting stress related to caring for a child with EGID is the mostsignificant predictor of increased HCU. Child's illness severity was not a significant predictorof HCU when controlling for PCS. Understanding the role frequent parental stress may havein the care of children with EGIDs warrants further investigation.

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Preliminary Validation of a Measure of Adult Eosinophilic Esophagitis PatientReported OutcomesTiffany Taft, Emily Kern, Monika A. Kwiatek, Ikuo Hirano, Nirmala Gonsalves, LaurieKeefer

Introduction: Patient Reported Outcomes (PROs) are becoming increasingly important inevaluating patient care, with Health Related Quality of Life (HRQOL) being an often evaluatedoutcome. Eosinophilic Esophagitis (EoE) is a chronic inflammatory disease of the esophagusthat results in significant symptoms and often requires challenging dietary and medicationregimens. Currently there is no research related to PROs among EoE patients. Our aim isto develop a reliable and valid measure of adult EoE HRQOL. Methods: EoE pts aged 18-70 were recruited via an outpatient GI clinic and 2 EoE advocacy groups (APFED, CURED).In addition to demographic and clinical information pts completed the EoE-PRO, a 47-itemmeasure developed from a semi-structured EoE pt interview. A subset of pts was contacted2 weeks after initial submission to repeat the EoE-PRO. Cronbach's α and Guttman's split-half measured scale reliability. Pearson's correlations evaluated test-retest reliability withitems < 0.5 removed. Principle components factor analysis with varimax rotation assessedthe EoE-PRO's factor structure. Results: 158 pts participated; 64 completed the EoE-PROtwice (mean=37 days elapsed). Mean±SD age was 36.9±11.5 yrs, 96% were Caucasian, 54%female, 72% college educated. Pts had EoE for 9.3±10.5 yrs and took 5 yrs on avg. to obtaindiagnosis. 61% were currently symptomatic, 86% experienced symptoms at least 1x/yr. Ptsrated their most recent episode-severity at 6.0±2.6/10. 70% used dietary therapies and 37%used oral steroids in the past month. Two EoE-PRO items failed to meet minimum test-retest criteria (0.18, 0.46) and were excluded prior to additional analysis. Remaining itemtest-retest correlations were 0.54-0.88 (all p<.01). Total score test-retest reliability was verygood (r=0.86, p<.01). The EoE-PRO showed excellent internal consistency (α=.97) andsplit-half reliability (Guttman=.89). Factor analysis yielded a 6 factor structure: Social Anxiety(n=11, α=.93), Diet Frustration (n=11, α=.94), Negative Affect (n=8, α=.91), Illness Anxiety(n=7,α=.91), Swallowing Anxiety (n=4,α=.92), and Disclosure (n=2,α=.70). After reviewing

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factor item-correlations, 2 items were removed for poor fit. The “Disclosure” scale wasremoved due to a poor α and incongruence with the HRQOL construct resulting in a 5scale, 41-item measure. Conclusions: (1) The EoE-PRO is a 5 scale instrument that assessesHRQOL issues specific to adult EoE pts. (2) The EoE-PRO demonstrated excellent internalconsistency, split-half and test-retest reliability. (3) Further refinement and item reductionwill enhance the utilization of the EoE PRO.

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Utility of the Mayo Dysphagia Questionnaire-30 Day for Prediction ofHistologic and Endoscopic Findings in Eosinophilic Esophagitis (EoE)Karthik Ravi, Amy E. Foxx-Orenstein, Yvonne Romero, Dawn L. Francis

Background: There is no validated symptom measure of dysphagia for use in EoE. The MayoDysphagia Questionnaire - 30 Day (MDQ-30) has previously been validated in patients withesophageal stricture. Aim: To assess the MDQ-30 in patients with EoE. Methods: 41 patientswith EoE enrolled in a prospective study to evaluate the role of GERD in EoE, underwent24 hour ambulatory pH testing, were treated with either a proton pump inhibitor orbudesonide suspension for 6 weeks, and had a follow-up esophagogastroduodenoscopy(EGD) with 6 mid and 6 distal esophageal biopsies. Patients completed the MDQ-30 within1 week before and immediately after treatment. The MDQ-30 was used to generate adysphagia score. We used the identical scoring system validated for stricture patients, anda sensitive score of 15 and specific score of 40 were identified using an ROC curve. (Figure1) Fisher's exact test assessed the association between dysphagia resolution, as assessed bythe MDQ-30 score, and histologic response (<5 eos per HPF after treatment) and endoscopicfindings of EoE (rings or furrows). Results: Utilizing a MDQ-30 cutoff score of 15, 32patients had dysphagia at baseline with resolution seen in 19 at follow up. Histologic responsewas similar in patients with and without dysphagia resolution, occurring in 74% and 69%respectively, with a sensitivity of 61% and specificity of 44%. Utilizing a MDQ-30 cutoffscore of 40, 15 patients had dysphagia at baseline with resolution seen in 13 followingtreatment. Histologic response was similar in patients with and without dysphagia resolution,occurring in 69% and 50% respectively, with a sensitivity of 90% and specificity of 20%.(Table 1) Utilizing the cutoff score of 15, 21/32 (66%) patients with dysphagia had endoscopicfindings of EoE at baseline. Findings of EoE were more likely to persist at follow up inthose with persistent dysphagia compared to those with dysphagia resolution, 88% versus62%, although not reaching statistical significance. Endoscopic findings of EoE were seenin 10 patients with dysphagia at baseline utilizing the cutoff score of 40. Dysphagia resolutionwas seen in all 10, with persistent endoscopic findings of EoE seen in 7. Conclusions:Symptoms of significant dysphagia, as assessed by the MDQ-30, are associated more stronglywith endoscopic rather than histologic findings in EoE. This suggests that structural changes,not esophageal eosinophilic infiltration, may determine symptoms in patients with EoE.Alternatively, the disassociation between histologic findings and dysphagia may be a functionof the MDQ-30, as its scoring system is based on patients with stricture. Further studiesassessing the correlation between histologic and endoscopic findings in EoE and the potentialuse of a weighted dysphagia questionnaire designed specifically for EoE are needed.Table 1: Correlation between Dysphagia and Histology and Endoscopic Findings

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