Practice patterns for the evaluation and treatment of eosinophilic oesophagitis

Abstract

Background: Although consensus guidelines for eosinophilic oesophagitis have been published, it remains unclear whether gastroenterologists follow these recommendations.

Aim: To assess academic and community practice patterns for the evaluation and treatment of eosinophilic oesophagitis and to compare these practices with current guidelines.

Methods: This was a prospective study of academic and community gastroenterologists using a self-administered online survey.

Results: A total of 60% (34 of 57) of academic and 29% (38 of 133) of community gastroenterologists completed the survey. Only 24% of academic and 3% of community gastroenterologists follow consensus guidelines to diagnose eosinophilic oesophagitis (P = 0.007). A proton pump inhibitor trial or negative pH study prior to diagnosis was required by just 25% of all gastroenterologists. A majority (60%) do not use the recommended threshold of 15 eosinophils per high powered field to diagnosis eosinophilic oesophagitis. Half (51%) mistakenly require a positive endoscopic finding. For first-line treatment, about half of the gastroenterologists surveyed treat with a swallowed topical steroid (53% academic, 56% community; P = N.S.), consistent with the guidelines.

Conclusions: There is variability in practice patterns for both diagnosis and treatment of eosinophilic oesophagitis. Ongoing education and research concerning diagnosis and treatment are needed.

Figure 1

Figure 1a. Number of esophageal biopsies obtained when considering EoE diagnosis. The proportion of academic gastroenterologists obtaining biopsies are in dark bars, and the community gastroenterologists are in light bars. While there was heterogeneity in the number of biopsies taken overall, academic gastroenterologists are more likely to take 9 or more biopsies compared with community gastroenterologists. Figure 1b. Threshold of eosinophils per high power when making a diagnosis of EoE. Academic gastroenterologists are in dark bars and community gastroenterologists are in light bars. Of the multiple cut-points reported, academic gastroenterologists are more likely to use a threshold of 15 eosinophils per high-power field.

Figure 1

Figure 1a. Number of esophageal biopsies obtained when considering EoE diagnosis. The proportion of academic gastroenterologists obtaining biopsies are in dark bars, and the community gastroenterologists are in light bars. While there was heterogeneity in the number of biopsies taken overall, academic gastroenterologists are more likely to take 9 or more biopsies compared with community gastroenterologists. Figure 1b. Threshold of eosinophils per high power when making a diagnosis of EoE. Academic gastroenterologists are in dark bars and community gastroenterologists are in light bars. Of the multiple cut-points reported, academic gastroenterologists are more likely to use a threshold of 15 eosinophils per high-power field.

Figure 2

Figure 2a. Total daily dose fluticasone. Academic gastroenterologists are in dark bars and community gastroenterologists are in light bars. While there is a range of doses used, there are no differences between the two provider groups. Figure 2b. Duration of fluticasone therapy. Academic gastroenterologists are in dark bars and community gastroenterologists are in light bars. While there is a range in the length of therapy prescribed, there are no differences between the two provider groups.

Figure 2

Figure 2a. Total daily dose fluticasone. Academic gastroenterologists are in dark bars and community gastroenterologists are in light bars. While there is a range of doses used, there are no differences between the two provider groups. Figure 2b. Duration of fluticasone therapy. Academic gastroenterologists are in dark bars and community gastroenterologists are in light bars. While there is a range in the length of therapy prescribed, there are no differences between the two provider groups.