Comparing Current Practice Patterns and Practice Guidelines for the Diagnosis and Management of Eosinophilic Esophagitis in the United States

Abstract

Introduction: While guidelines exist for the diagnosis and management of EoE, the current real-world practice patterns among gastroenterologists are not well-described. The aim is to assess practice patterns of EoE diagnosis and management among gastroenterologists in the United States and whether practice is concordant with EoE consensus guidelines. Methods: We conducted a cross-sectional online survey of academic and community gastroenterologists in the United States. The survey was designed using QualtricsTM and comprised of 35 questions over four categories: EoE symptoms & endoscopic findings, EoE diagnosis, EoE treatment, and respondent characteristics. The survey was dispersed through the North Carolina Society of Gastroenterology (NCSG) and American College of Gastroenterology (ACG) member listserves. A similar survey was sent to NCSG members in 2010 and responses were compared in a sub-analysis. Results: Of 240 respondents, 239 (99.6%) reported having cared for a EoE patient, 37% (n=80) worked in a community practice, and 63% (n=138) in an academic setting. Providers saw a median of 18 (IQR 2-100) EoE patients per month. Of the group, 24% (n=52) reported being “very familiar” with EoE consensus guidelines. A proton-pump inhibitor (PPI) trial was required by only 37% of providers prior to making a definitive EoE diagnosis (Figure). 60% used a ≥15 eos/hpf cut-point for EoE diagnosis and 62% biopsied from the proximal and distal esophagus on initial exam. Only 12% (n=28) followed guideline recommendations for EoE diagnosis. For first-line treatment, 7% used dietary therapy, 32% used topical steroids, and 61% used PPIs; 67% used fluticasone as first-line steroid; 41% used maintenance steroid treatment in responders. 63% dilated critical/symptomatic strictures and 54% used balloon dilation. There were significant differences in practice patterns between those working in academic vs. community settings in EoE diagnosis and treatment (Table 1). In the NCSG cohort, a higher proportion in 2017 followed guideline recommendations for diagnosis compared to 2010 (14% vs. 3%; p=0.03) and used dietary therapy as first-line treatment (13% vs 3%; p=0.046) (Table 2). Conclusion: There is variability in practice patterns for both diagnosis and treatment of EoE that differ from consensus guidelines, and between gastroenterologists practicing in academic versus community practices. Further education and guideline dissemination is needed to standardize practice for EoE.376_A Figure 1 No Caption available.376_B Figure 2 No Caption available.376_C Figure 3 No Caption available.