Emily D. Belcher, BS, Gregory D. Salinas, PhD, Sylvie Stacy, MD, MPH CE Outcomes, LLC, Birmingham, AL
Introduction: Studies have shown eosinophilic esophagitis (EoE) is misdiagnosed and mismanaged. We hypothesized that surveying clinicians who manage EoE would identify attitudes and gaps in knowledge that could be addressed in continuing educational activities with the goal of improving evidence-based management of EoE.
Methods: A survey using simulated patient cases was developed to identify current practice patterns of US gastroenterologists (GIs) related to EoE management. The survey was fielded online January 2021 via direct email. Descriptive analysis was used to determine overall educational needs and gaps. Subanalysis of final data observed differences between subgroups that manage adult and pediatric patients.
Results: Responses from a total of 175 US GIs were collected for analysis, including 125 managing primarily adults and 50 managing pediatric patients.
When presented a case of a patient with recently diagnosed EoE, most GIs would start pharmacotherapy and 57% would recommend dietary therapy, with half indicating both. However, there was little consensus on the specifics of either approach. Half of GIs would use a combination of PPI and topical steroids for initial management. If initial PPI and topical steroids fail, 38% of GIs would switch to different options within the same class, 24% would use systemic steroids, and 15% would recommend a biologic. Of the GIs who would attempt dietary therapy, 85% would recommend an elimination diet (empiric and/or testing-directed), while 58% would treat with other diet changes, make only general dietary recommendations, or defer to a dietitian.
On their approach to assessing patient adherence, GIs most commonly report monitoring symptoms or discussing adherence directly with the patient. Symptoms were the primary mechanism reported by GIs for determining initial therapeutic approach and monitoring patient response to treatment.
Most adult GIs report referring to ACG guidelines to help manage their patients with EoE; pediatric GIs also use ESPGHAN guidelines. GIs view guidelines as one of the most useful means for staying updated on EoE, along with journal articles and medical conferences.
Discussion: This study highlights gaps in EoE management among GIs. Future educational initiatives should incorporate treatment approaches including recommended dietary and pharmacologic therapy regimens. Further, guidance is needed on how to monitor patients, as guidelines recommend against using symptoms alone to determine disease activity and response to therapy.
Emily Belcher indicated no relevant financial relationships.
Gregory Salinas indicated no relevant financial relationships.
Sylvie Stacy indicated no relevant financial relationships.
Emily D. Belcher, BS, Gregory D. Salinas, PhD, Sylvie Stacy, MD, MPH. P2389 - Educational Needs in the Gastroenterologist Approach to Managing Patients With EoE: A Case-Based Survey Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.