Educational needs in the management of patients with eosinophilic esophagitis: results of a US-based multispecialty case survey

Abstract BackgroundGiven that the incidence of eosinophilic esophagitis (EoE) has been increasing, it is crucial that physicians are able to identify EoE, begin appropriate treatment, adjust treatment as needed, and work with patients to ensure adherence.AimsThe purpose of this study was to understand physician practice patterns and perceptions relating to EoE management.MethodsA patient case-based survey was developed to investigate physician practices related to the management of EoE. It was distributed to primary care physicians, allergists, gastroenterologists, and emergency physicians in January 2021.ResultsWhen respondents (n = 652) were presented a patient with newly diagnosed EoE who had trialed a proton pump inhibitor, only about half would begin combination pharmacotherapy and dietary therapy. Of those beginning pharmacotherapy, 75% would recommend a topical glucocorticoid and 68% would continue a PPI. There was no consensus regarding specific recommendations for dietary therapy. In refractory EoE, more allergists (39%) would begin a biologic agent than other physicians (14%). Though the majority of pediatricians (62%) would defer to a gastroenterologist specialist, fewer PCPs (43%) or allergists (9%) would do so. More allergists and gastroenterologists than other specialty types indicated that their EoE management is guided by a standard approach. The most significant barrier to optimal management was felt to be poor patient adherence, though 25% of physicians would not routinely assess adherence at follow-up.ConclusionsResults highlight current gaps in managing EoE, which can inform areas of focus for future educational activities, potentially leading to less practice variation and increased use of evidence-based decision-making.