Practice patterns for the evaluation and treatment of eosinophilic oesophagitis

Aliment Pharmacol Ther. 2010 Dec;32(11-12):1373-82. doi: 10.1111/j.1365-2036.2010.04476.x. Epub 2010 Oct 5.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers / standards
  • Adrenal Cortex Hormones / administration & dosage*
  • Attitude of Health Personnel*
  • Community Health Services / standards
  • Esophagitis / physiopathology*
  • Esophagitis / therapy*
  • Gastroenterology
  • Guideline Adherence / standards*
  • Humans
  • Internet
  • Practice Guidelines as Topic
  • Prospective Studies
  • Proton Pump Inhibitors / administration & dosage*
  • Surveys and Questionnaires

Substances

  • Adrenal Cortex Hormones
  • Proton Pump Inhibitors