- Email: [email protected]
A Diagnosis of Eosinophilic Esophagitis is Associated with Increased Life Insurance Premiums
AGA Abstracts
rate, irrespective of gender, for the 48-year-old case without EoE (n=26) was $1990 (IQR $1248-2350), which was 19% less expensive when compared to a case with EoE (n=14) at $2375 (IQR $2100-2568; p=0.02) (Figure). In contrast, there was no significant difference in premiums between EoE and non-EoE groups for the 25-year-old test case (p=0.1). Neither gender nor the state from which quotes were obtained was significantly associated with premium rates. Conclusions Although no data exist to suggest patients with EoE have a diminished life expectancy, life insurance premiums were significantly more expensive in the older patient case with this diagnosis when compared to similar cases without a diagnosis of EoE. This finding does not seem to be explained on the basis of gender or state of residence. While healthcare utilization may be higher in EoE patients, it remains unclear why this diagnosis would translate to higher life insurance premiums. Further work to educate insurance companies on the potential risks associated with EoE is warranted, and patients with EoE and their providers should be aware of the additional lifestyle "costs" associated with this diagnosis.
Tu1123 SOCIAL IMPACTS ON HEALTH RELATED QUALITY OF LIFE IN EOSINOPHILIC GASTRITIS AND GASTROENTERITIS (EGE) Tiffany Taft, Alyse Bedell, Livia Guadagnoli, Meredith Craven, Ikuo Hirano, Nirmala Gonsalves Introduction: Eosinophilic gastrointestinal disorders, including gastritis and gastroenteritis (EGE), typically present with significant symptoms such as abdominal pain, nausea/vomiting, diarrhea and weight loss with potential for considerable impacts on health-related quality of life (HRQOL). Prior studies evaluate HRQOL in eosinophilic esophagitis; this is the first study to investigate HRQOL in EGE. We aim to describe social impacts of HRQOL via qualitative interviews. Methods: Six adults (4 male, 2 female) with EGE for at least 6 months recruited from an outpatient university based gastroenterology practice completed a semistructured interview. Utilizing the multidimensional HRQOL definition as a framework, patients were asked about social interactions, perceptions of EGE burden and barriers related to these interactions, and attitudes towards the social impact of EGE. Thematic Analysis and Grounded Theory were used for analysis. Results: Three themes emerged: 1) broader social interactions, 2) family interactions, 3) behavior modifications. All participants discussed ways social interactions are impacted by EGE including: receiving negative comments and/ or attention from others, embarrassment, avoidance, and social isolation. These issues are salient earlier in diagnosis and did not cause significant distress at the time of interview. All participants discussed how their ability to navigate and enjoy social situations is dependent on others' degree of EGE understanding. Higher health literacy among EGE patients and their social supports is associated with more positive social exchanges. All participants discussed an improvement in degree of social impact of EGE over time and an improvement in their ability to adapt to social situations. A broad range of experiences with family were reported including: family's concern/worry, patient's perception of being a burden on family, family's difficulty understanding EGE, and limited participation in family cultural traditions and roles due to EGE. All participants were married or in a committed relationship and most reported a strong degree of support from their partner. Three participants reported a negative impact on sex drive due to EGE. All participants endorsed behavior modifications to prepare for social events including: reviewing restaurant menus online, bringing/cooking one's own food, eating before, or avoiding eating. Conclusions: Qualitative interviews with EGE patients revealed a range of experiences that can aid providers' understanding of the unique effects EGE has on patient lives. EGE impacts social functioning, particularly in regard to social isolation, stigma, and compensatory behaviors when engaging in social activities involving food. Social impacts appear to improve over time following diagnosis. HRQOL in EGE warrants further inquiry, including multicultural considerations.
The median life insurance premium rate for patients with eosinophilic esophagitis is significantly higher (p=0.02) among the mature group than their aged-match controls, which was not seen among the young group (p=0.1).
Tu1125 EOSINOPHIL INTEGRIN αM (CD11B/MAC-1) PROMOTES EOSINOPHILIC ESOPHAGITIS THROUGH INTERACTION WITH EPITHELIAL-DERIVED PERIOSTIN Alexandra Farris, Dorothea Letner, Praveen Vimal, Vikram Deshpande, Vijay Yajnik, Wayne G. Shreffler, John Garber Background: A key area of uncertainly in EoE pathogenesis is the identification of factors that permit or actively promote the recruitment of eosinophils from the circulation into the esophageal epithelium. Human eosinophils express seven integrin heterodimers, α4β1 (CD49d/CD29), α6β1 (CD49f/CD29), αLβ2 (CD11a/CD18), αMβ2 (CD11b/CD18), αXβ2 (CD11c/CD18), αDβ2 (CD11d/CD18), and α4β7 (CD49d/β7), which interact with endothelial- and epithelial-expressed ligands or components of the extracellular matrix. In the context of EoE, very little is known about the specific interactions between these integrins and corresponding adhesion molecules that determine the spatiotemporal regulation of eosinophil extravasation and tissue accumulation. Aims: We sought to determine EoE-specific integrin expression patterns on esophageal eosinophils and to determine how specific engagement of integrin αM (CD11b), which is capable of binding tissue-derive periostin, influences eosinophil survival and activation. Methods: Esophageal and peripheral eosinophils were isolated from 20 adult subjects with active EoE for immunophenotyping and integrin expression profiling using multicolor flow cytometry and immunohistochemistry. Purified circulating and tissue eosinophils were used to assess the effect of increased CD11b expression on adherence to recombinant periostin as well as to the esophageal epithelium in a novel coculture model of eosinophils and primary esophageal epithelial cells isolated from subjects with varying disease activity. Finally, we sought to test the effect of soluble periostin on the expression of major eosinophil integrins. Results: Resting eosinophils express high levels of α4β7 and the β2-pairing integrins αL and αM, and low levels of αD and α6. Tranendothelial migration in the setting of esophageal accumulation is characterized by significant induction of integrin αM, whereas there is no significant change in the other integrins (Figure 1). Increased CD11b expression enhances eosinophil adhesion to periostin and short-term incubation of naïve eosinophils with human recombinant periostin in the presence of IL-5 induced a significant increase in CD11b surface expression, which was not observed during treatment with IL-13 or eotaxin-3 (Figure 2). Conclusions: Integrin αM/CD11b is a specific marker of activated tissue eosinophils in EoE and mediates eosinophil adhesion and activation through binding epithelial-derived periostin. Given the ability of CD11b to mediate eosinophil adhesion and migration via periostin, this represents a mechanism for eosinophil-epithelial crosstalk and potential therapeutic target in EoE.
Tu1124 A DIAGNOSIS OF EOSINOPHILIC ESOPHAGITIS IS ASSOCIATED WITH INCREASED LIFE INSURANCE PREMIUMS David A. Leiman, Bharati Kochar, Shai Posner, Claire Fan, Amit Patel, Olivia Shaheen, Catherine Keller, Nathaniel T. Koutlas, Swathi Eluri, Evan S. Dellon Background and Aims Eosinophilic esophagitis (EoE) is a chronic immune antigen-mediated disease that is diagnosed in children and adults and is currently without a cure. No data describe EoE as a pre-malignant condition or show that it shortens lifespan, but therapy is often required indefinitely. Patients with EoE also have significantly higher healthcare utilization than similarly aged controls. It remains unknown whether a diagnosis of EoE affects insurability or insurance premium costs. We aimed to determine whether a diagnosis of EoE affects the costs of life insurance. Methods Our multicenter study group contacted national life insurance companies to evaluate the effects of a diagnosis of EoE on life insurance premiums. Two similar male and female base cases were created, including a 25-year-old Caucasian non-smoker ("young") and a 48-year-old Caucasian non-smoker ("mature"), both without other comorbid conditions except for a diagnosis of EoE. We selected a residential address for each test case in one state on the East Coast, West Coast and the Midwest. Companies were asked for their best estimate for a whole life insurance policy in the amount of $100,000. Quotes were either provided over the phone or in follow-up e-mails. Comparisons between median premiums for each group were made using the Mann-Whitney U test. Results Twenty national life insurance companies were contacted in North Carolina, Wisconsin and California and a total of 73 quotes were obtained. The median premium
AGA Abstracts
S-870
rate, irrespective of gender, for the 48-year-old case without EoE (n=26) was $1990 (IQR $1248-2350), which was 19% less expensive when compared to a case with EoE (n=14) at $2375 (IQR $2100-2568; p=0.02) (Figure). In contrast, there was no significant difference in premiums between EoE and non-EoE groups for the 25-year-old test case (p=0.1). Neither gender nor the state from which quotes were obtained was significantly associated with premium rates. Conclusions Although no data exist to suggest patients with EoE have a diminished life expectancy, life insurance premiums were significantly more expensive in the older patient case with this diagnosis when compared to similar cases without a diagnosis of EoE. This finding does not seem to be explained on the basis of gender or state of residence. While healthcare utilization may be higher in EoE patients, it remains unclear why this diagnosis would translate to higher life insurance premiums. Further work to educate insurance companies on the potential risks associated with EoE is warranted, and patients with EoE and their providers should be aware of the additional lifestyle "costs" associated with this diagnosis.
Tu1123 SOCIAL IMPACTS ON HEALTH RELATED QUALITY OF LIFE IN EOSINOPHILIC GASTRITIS AND GASTROENTERITIS (EGE) Tiffany Taft, Alyse Bedell, Livia Guadagnoli, Meredith Craven, Ikuo Hirano, Nirmala Gonsalves Introduction: Eosinophilic gastrointestinal disorders, including gastritis and gastroenteritis (EGE), typically present with significant symptoms such as abdominal pain, nausea/vomiting, diarrhea and weight loss with potential for considerable impacts on health-related quality of life (HRQOL). Prior studies evaluate HRQOL in eosinophilic esophagitis; this is the first study to investigate HRQOL in EGE. We aim to describe social impacts of HRQOL via qualitative interviews. Methods: Six adults (4 male, 2 female) with EGE for at least 6 months recruited from an outpatient university based gastroenterology practice completed a semistructured interview. Utilizing the multidimensional HRQOL definition as a framework, patients were asked about social interactions, perceptions of EGE burden and barriers related to these interactions, and attitudes towards the social impact of EGE. Thematic Analysis and Grounded Theory were used for analysis. Results: Three themes emerged: 1) broader social interactions, 2) family interactions, 3) behavior modifications. All participants discussed ways social interactions are impacted by EGE including: receiving negative comments and/ or attention from others, embarrassment, avoidance, and social isolation. These issues are salient earlier in diagnosis and did not cause significant distress at the time of interview. All participants discussed how their ability to navigate and enjoy social situations is dependent on others' degree of EGE understanding. Higher health literacy among EGE patients and their social supports is associated with more positive social exchanges. All participants discussed an improvement in degree of social impact of EGE over time and an improvement in their ability to adapt to social situations. A broad range of experiences with family were reported including: family's concern/worry, patient's perception of being a burden on family, family's difficulty understanding EGE, and limited participation in family cultural traditions and roles due to EGE. All participants were married or in a committed relationship and most reported a strong degree of support from their partner. Three participants reported a negative impact on sex drive due to EGE. All participants endorsed behavior modifications to prepare for social events including: reviewing restaurant menus online, bringing/cooking one's own food, eating before, or avoiding eating. Conclusions: Qualitative interviews with EGE patients revealed a range of experiences that can aid providers' understanding of the unique effects EGE has on patient lives. EGE impacts social functioning, particularly in regard to social isolation, stigma, and compensatory behaviors when engaging in social activities involving food. Social impacts appear to improve over time following diagnosis. HRQOL in EGE warrants further inquiry, including multicultural considerations.
The median life insurance premium rate for patients with eosinophilic esophagitis is significantly higher (p=0.02) among the mature group than their aged-match controls, which was not seen among the young group (p=0.1).
Tu1125 EOSINOPHIL INTEGRIN αM (CD11B/MAC-1) PROMOTES EOSINOPHILIC ESOPHAGITIS THROUGH INTERACTION WITH EPITHELIAL-DERIVED PERIOSTIN Alexandra Farris, Dorothea Letner, Praveen Vimal, Vikram Deshpande, Vijay Yajnik, Wayne G. Shreffler, John Garber Background: A key area of uncertainly in EoE pathogenesis is the identification of factors that permit or actively promote the recruitment of eosinophils from the circulation into the esophageal epithelium. Human eosinophils express seven integrin heterodimers, α4β1 (CD49d/CD29), α6β1 (CD49f/CD29), αLβ2 (CD11a/CD18), αMβ2 (CD11b/CD18), αXβ2 (CD11c/CD18), αDβ2 (CD11d/CD18), and α4β7 (CD49d/β7), which interact with endothelial- and epithelial-expressed ligands or components of the extracellular matrix. In the context of EoE, very little is known about the specific interactions between these integrins and corresponding adhesion molecules that determine the spatiotemporal regulation of eosinophil extravasation and tissue accumulation. Aims: We sought to determine EoE-specific integrin expression patterns on esophageal eosinophils and to determine how specific engagement of integrin αM (CD11b), which is capable of binding tissue-derive periostin, influences eosinophil survival and activation. Methods: Esophageal and peripheral eosinophils were isolated from 20 adult subjects with active EoE for immunophenotyping and integrin expression profiling using multicolor flow cytometry and immunohistochemistry. Purified circulating and tissue eosinophils were used to assess the effect of increased CD11b expression on adherence to recombinant periostin as well as to the esophageal epithelium in a novel coculture model of eosinophils and primary esophageal epithelial cells isolated from subjects with varying disease activity. Finally, we sought to test the effect of soluble periostin on the expression of major eosinophil integrins. Results: Resting eosinophils express high levels of α4β7 and the β2-pairing integrins αL and αM, and low levels of αD and α6. Tranendothelial migration in the setting of esophageal accumulation is characterized by significant induction of integrin αM, whereas there is no significant change in the other integrins (Figure 1). Increased CD11b expression enhances eosinophil adhesion to periostin and short-term incubation of naïve eosinophils with human recombinant periostin in the presence of IL-5 induced a significant increase in CD11b surface expression, which was not observed during treatment with IL-13 or eotaxin-3 (Figure 2). Conclusions: Integrin αM/CD11b is a specific marker of activated tissue eosinophils in EoE and mediates eosinophil adhesion and activation through binding epithelial-derived periostin. Given the ability of CD11b to mediate eosinophil adhesion and migration via periostin, this represents a mechanism for eosinophil-epithelial crosstalk and potential therapeutic target in EoE.
Tu1124 A DIAGNOSIS OF EOSINOPHILIC ESOPHAGITIS IS ASSOCIATED WITH INCREASED LIFE INSURANCE PREMIUMS David A. Leiman, Bharati Kochar, Shai Posner, Claire Fan, Amit Patel, Olivia Shaheen, Catherine Keller, Nathaniel T. Koutlas, Swathi Eluri, Evan S. Dellon Background and Aims Eosinophilic esophagitis (EoE) is a chronic immune antigen-mediated disease that is diagnosed in children and adults and is currently without a cure. No data describe EoE as a pre-malignant condition or show that it shortens lifespan, but therapy is often required indefinitely. Patients with EoE also have significantly higher healthcare utilization than similarly aged controls. It remains unknown whether a diagnosis of EoE affects insurability or insurance premium costs. We aimed to determine whether a diagnosis of EoE affects the costs of life insurance. Methods Our multicenter study group contacted national life insurance companies to evaluate the effects of a diagnosis of EoE on life insurance premiums. Two similar male and female base cases were created, including a 25-year-old Caucasian non-smoker ("young") and a 48-year-old Caucasian non-smoker ("mature"), both without other comorbid conditions except for a diagnosis of EoE. We selected a residential address for each test case in one state on the East Coast, West Coast and the Midwest. Companies were asked for their best estimate for a whole life insurance policy in the amount of $100,000. Quotes were either provided over the phone or in follow-up e-mails. Comparisons between median premiums for each group were made using the Mann-Whitney U test. Results Twenty national life insurance companies were contacted in North Carolina, Wisconsin and California and a total of 73 quotes were obtained. The median premium
AGA Abstracts
S-870