Clinical management of eosinophilic esophagitis – a nationwide survey among gastroenterologists in Germany

2019 ◽  
Vol 57 (06) ◽  
pp. 745-752 ◽  
Author(s):  
Stephan Miehlke ◽  
Ulrike von Arnim ◽  
Christoph Schlag ◽  
Thomas Frieling ◽  
Ahmed Madisch ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Clinical Management ◽  
Elimination Diet ◽  
Esophageal Disease ◽  
Dietary Therapy ◽  
High Dose ◽  
Topical Steroids ◽  
Allergy Test ◽  
Long Term Treatment ◽  
Food Elimination

Abstract Background Eosinophilic esophagitis (EoE) is an increasingly recognized immune-mediated esophageal disease and a common cause for dysphagia and food bolus obstruction. The aim of this study was to evaluate the current clinical management of EoE among adult gastroenterologists in Germany. Methods We performed a cross-sectional study of 1393 adult gastroenterologists using a questionnaire containing 22 questions to general, diagnostic, and therapeutic aspects of EoE. The self-administered online survey was conducted between November 2017 and February 2018. Data capture and analysis was performed using SurveyMonkey. Results The overall responder rate was 29.6 %. More than half of the responders (54.9 %) felt to observe a significant increase of EoE patients. The EREFS score was mostly either unknown (44.3 %) or not routinely used (52.2 %). If EoE was suspected, most responders obtained multiple esophageal biopsies (n = 3 – 4: 35.7 %; n > 4: 61.6 %). The preferred primary treatment was proton pump inhibitors (PPI) in 37.2 % and topical steroids in 35.0 % of responders. PPI regimens were highly diverse, with only half of responders using high-dose PPI regimens. Allergy testing was often initiated (always 25.4 %, sometimes 48.9 %). The most common dietary therapy was 6-food elimination diet (52 %), followed by allergy test-directed diets (16 %) and 2-food elimination diet (16.5 %). The majority of responders indicated a need for long-term treatment (i. e., 23 % of responders in > 50 % their patients and 47.7 % of responders in 25 – 50 % of their patients). Conclusions Among gastroenterologists in Germany, substantial variation in the adherence to published EoE guidelines appears to exist. This indicates the need for intensified education and national guidelines in order to optimize and harmonize the clinical management of EoE patients.

scholarly journals Combined and Alternating Topical Steroids and Food Elimination Diet for the Treatment of Eosinophilic Esophagitis

2018 ◽  
Vol 63 (9) ◽  
pp. 2381-2388 ◽  
Author(s):  
Craig C. Reed ◽  
Anca M. Safta ◽  
Shadi Qasem ◽  
M. Angie Almond ◽  
Evan S. Dellon ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Elimination Diet ◽  
Topical Steroids ◽  
Food Elimination

4 Six-Food Elimination Diet or Topical Steroids for First-Line Treatment of Eosinophilic Esophagitis: A Cost-Utility Analysis

2015 ◽  
Vol 148 (4) ◽  
pp. S-2 ◽  
Author(s):  
Cary C. Cotton ◽  
Sarah Hiller ◽  
Daniel J. Green ◽  
W. Asher Wolf ◽  
Stephanie B. Wheeler ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Elimination Diet ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Topical Steroids ◽  
Line Treatment ◽  
Utility Analysis ◽  
First Line ◽  
Food Elimination ◽  
First Line Treatment

scholarly journals A14 WIDE VARIATION IN CLINICAL MANAGEMENT OF PAEDIATRIC EOSINOPHILIC ESOPHAGITIS: A CANADIAN EXPERIENCE.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 16-18
Author(s):  
K A Bortolin ◽  
D Ashok ◽  
V Avinashi ◽  
J Barkey ◽  
D Burnett ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Eosinophilic Esophagitis ◽  
Online Survey ◽  
Treatment Algorithm ◽  
Elimination Diet ◽  
Practice Variation ◽  
Initial Diagnosis ◽  
Response To Therapy ◽  
Topical Steroids ◽  
Repeat Endoscopy

Abstract Background Eosinophilic esophagitis (EoE) is a chronic disorder treated by food elimination diet (FED), topical steroids and/or proton-pump inhibitors (PPI). Serial endoscopies and biopsies assess response to therapy. EoE management has evolved as guidelines are updated. Aims To identify practice variation among Canadian paediatric gastroenterologists (PG) who care for children with EoE. Methods An online survey using REDCap about decision-making in children with EoE was distributed to PG in Canada in November 2020. Results 62 PG completed the survey (response rate 69%, 62/94). The majority work in academic centres (92%). 3 centers indicated an accrual of >50 new patients per year; 9/16 centres have >100 patients in follow-up. An EoE Clinic is present in 5 centres. Diagnosis: Familiarity with the 2018 AGREE and 2020 AGA EoE guidelines was found to be 57% and 67% respectively. Criteria required to diagnose EoE according to current guidelines were correctly indicated by 42% of PG. (Figure 1). Endoscopy: The majority of PG (95%) adhere to guidelines in terms of required number and location of biopsies for the initial diagnosis. Ideal timing of repeat endoscopy after change in therapy in patients who are not in histological remission was 8–12 weeks by 67% of PG, timing in stable patients on maintenance therapy varied (33% only if patient is symptomatic). 25% used the EREFS Score in reporting endoscopic findings. Therapy: Improvement of symptoms was the highest ranked goal (64%), followed by remission of histologic findings (30%). A treatment algorithm was in place in 4 centers. The majority routinely assess adherence to therapy (73%) and consult a dietitian for FED (77%). Most (87%) do not consult an allergist for initial management. Preferred choices of 1st-line therapy varied among PG (Figure 2). When FED was selected, 32% of PG started with 1 food, 32% started with 2 foods, most frequently excluding dairy, followed by wheat. 14 (26%) start with ≥6 FED. Prescription of budesonide slurry was consistent among PG with doses of 1 and 2 mg/day in children <10 and >10 years, respectively. Conclusions The is the first Canadian study to assess the variation in management of children with EoE by PG. Overall, PG demonstrated good adherence to the guidelines in terms of initial diagnosis, but differences in maintenance therapy choice and timing of endoscopies. The results highlight a need for standardized management algorithms to deliver uniform care to this growing group. Grounding these guidelines in evidence will warrant a significant investment in further paediatric EoE research. Funding Agencies None

scholarly journals Practice patterns and adherence to clinical guidelines for diagnosis and management of eosinophilic esophagitis among gastroenterologists

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Swathi Eluri ◽  
Edward G A Iglesia ◽  
Michael Massaro ◽  
Anne F Peery ◽  
Nicholas J Shaheen ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Practice Patterns ◽  
Further Education ◽  
Dietary Therapy ◽  
Topical Steroids ◽  
Line Treatment ◽  
Consensus Guidelines ◽  
First Line ◽  
Diagnosis And Management ◽  
First Line Treatment

Summary Real-world practice patterns of eosinophilic esophagitis (EoE) among gastroenterologists are not well-described. The aim is to describe practice patterns of EoE diagnosis and management and assess concordance with consensus guidelines. We conducted a cross-sectional online survey of gastroenterologists in the USA using Qualtrics, which was dispersed through the North Carolina Society of Gastroenterology (NCSG) and the American College of Gastroenterology member listservs. A similar survey was sent to NCSG members in 2010 and responses were compared in a subanalysis. Of 240 respondents, 37% (n = 80) worked in an academic setting versus 63% (n = 138) community practice setting. Providers saw a median of 18 (interquartile range 2–100) EoE patients annually and 24% (n = 52) were ‘very familiar’ with EoE guidelines. A proton-pump inhibitor (PPI) trial was required by 37% of providers prior to EoE diagnosis. In total, 60% used a ≥15 eosinophils per high-power field cut point for diagnosis and 62% biopsied from the proximal and distal esophagus on initial exam. Only 12% (n = 28) followed EoE diagnosis guidelines. For first-line treatment, 7% used dietary therapy, 32% topical steroids, and 61% used PPIs; 67% used fluticasone as first-line steroid; 41% used maintenance steroid treatment in responders. In the NCSG cohort, a higher proportion in 2017 followed guideline diagnosis recommendations compared with 2010 (14% vs. 3%; P = 0.03) and a higher proportion used dietary therapy as first-line treatment (13% vs. 3%; P = 0.046). There is variability in EoE practice patterns for EoE management, with management differing markedly from consensus guidelines. Further education and guideline dissemination are needed to standardize practice.

Mo1202 LONG-TERM TREATMENT WITH PROTON PUMP INHIBITORS AND TOPICAL STEROIDS IN EOSINOPHILIC ESOPHAGITIS: EFFICACY AND FACTORS INFLUENCING RESPONSE

2020 ◽  
Vol 158 (6) ◽  
pp. S-825
Author(s):  
Matteo Ghisa ◽  
Giorgio Laserra ◽  
Brigida Barberio ◽  
Salvatore Tolone ◽  
Nicola de Bortoli ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Eosinophilic Esophagitis ◽  
Term Treatment ◽  
Topical Steroids ◽  
Factors Influencing ◽  
Long Term Treatment
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