Clinical management of eosinophilic esophagitis - a nationwide survey among gastroenterologists in Germany

TY - JOUR

T1 - Clinical management of eosinophilic esophagitis - a nationwide survey among gastroenterologists in Germany

AU - Miehlke, Stephan

AU - von Arnim, Ulrike

AU - Schlag, Christoph

AU - Frieling, Thomas

AU - Madisch, Ahmed

AU - Loibl, Rudolf

AU - Mainz, Dagmar

AU - Labenz, Joachim

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2019/6

Y1 - 2019/6

N2 - BACKGROUND:  Eosinophilic esophagitis (EoE) is an increasingly recognized immune-mediated esophageal disease and a common cause for dysphagia and food bolus obstruction. The aim of this study was to evaluate the current clinical management of EoE among adult gastroenterologists in Germany.METHODS:  We performed a cross-sectional study of 1393 adult gastroenterologists using a questionnaire containing 22 questions to general, diagnostic, and therapeutic aspects of EoE. The self-administered online survey was conducted between November 2017 and February 2018. Data capture and analysis was performed using SurveyMonkey.RESULTS:  The overall responder rate was 29.6 %. More than half of the responders (54.9 %) felt to observe a significant increase of EoE patients. The EREFS score was mostly either unknown (44.3 %) or not routinely used (52.2 %). If EoE was suspected, most responders obtained multiple esophageal biopsies (n = 3 - 4: 35.7 %; n > 4: 61.6 %). The preferred primary treatment was proton pump inhibitors (PPI) in 37.2 % and topical steroids in 35.0 % of responders. PPI regimens were highly diverse, with only half of responders using high-dose PPI regimens. Allergy testing was often initiated (always 25.4 %, sometimes 48.9 %). The most common dietary therapy was 6-food elimination diet (52 %), followed by allergy test-directed diets (16 %) and 2-food elimination diet (16.5 %). The majority of responders indicated a need for long-term treatment (i. e., 23 % of responders in > 50 % their patients and 47.7 % of responders in 25 - 50 % of their patients).CONCLUSIONS:  Among gastroenterologists in Germany, substantial variation in the adherence to published EoE guidelines appears to exist. This indicates the need for intensified education and national guidelines in order to optimize and harmonize the clinical management of EoE patients.

AB - BACKGROUND:  Eosinophilic esophagitis (EoE) is an increasingly recognized immune-mediated esophageal disease and a common cause for dysphagia and food bolus obstruction. The aim of this study was to evaluate the current clinical management of EoE among adult gastroenterologists in Germany.METHODS:  We performed a cross-sectional study of 1393 adult gastroenterologists using a questionnaire containing 22 questions to general, diagnostic, and therapeutic aspects of EoE. The self-administered online survey was conducted between November 2017 and February 2018. Data capture and analysis was performed using SurveyMonkey.RESULTS:  The overall responder rate was 29.6 %. More than half of the responders (54.9 %) felt to observe a significant increase of EoE patients. The EREFS score was mostly either unknown (44.3 %) or not routinely used (52.2 %). If EoE was suspected, most responders obtained multiple esophageal biopsies (n = 3 - 4: 35.7 %; n > 4: 61.6 %). The preferred primary treatment was proton pump inhibitors (PPI) in 37.2 % and topical steroids in 35.0 % of responders. PPI regimens were highly diverse, with only half of responders using high-dose PPI regimens. Allergy testing was often initiated (always 25.4 %, sometimes 48.9 %). The most common dietary therapy was 6-food elimination diet (52 %), followed by allergy test-directed diets (16 %) and 2-food elimination diet (16.5 %). The majority of responders indicated a need for long-term treatment (i. e., 23 % of responders in > 50 % their patients and 47.7 % of responders in 25 - 50 % of their patients).CONCLUSIONS:  Among gastroenterologists in Germany, substantial variation in the adherence to published EoE guidelines appears to exist. This indicates the need for intensified education and national guidelines in order to optimize and harmonize the clinical management of EoE patients.

KW - Adult

KW - Cross-Sectional Studies

KW - Diet Therapy/methods

KW - Eosinophilic Esophagitis/diagnosis

KW - Gastroenterologists/psychology

KW - Gastroenterology

KW - Germany

KW - Glucocorticoids/therapeutic use

KW - Guideline Adherence

KW - Humans

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'

KW - Proton Pump Inhibitors/therapeutic use

KW - Surveys and Questionnaires

U2 - 10.1055/a-0885-1963

DO - 10.1055/a-0885-1963

M3 - SCORING: Journal article

C2 - 31170743

VL - 57

SP - 745

EP - 752

JO - Z GASTROENTEROL

JF - Z GASTROENTEROL

SN - 0044-2771

IS - 6

ER -