BEYOND DYSPHAGIA: RESULTS OF A SURVEY AMONG ROMANIAN GASTROENTEROLOGISTS REGARDING THEIR DIAGNOSIS AND MANAGEMENT OF EOSINOPHILIC ESOPHAGITIS
Abstract
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation on esophageal biopsies. EoE prevalence increased in recent years and nowadays it is recognized as a common cause of dysphagia and food impaction. Despite the publication of updated guidelines, multiple studies reported variable clinical practices regarding the management of EoE patients. The aim of this study was to assess the adherence to published guidelines and the current clinical management of EoE among gastroenterologists from three academic centers in Romania. Material and methods: We performed a cross-sectional study of 62 gastroenterologists using a 12-item questionnaire probing the clinicians’ understanding of EoE diagnosis and therapeutic guidelines. The online survey was conducted between 15th of February and 15th of March 2022 and the data was processed using SurveyPlanet. Results: The overall completion rate was 100% and the mean time of completion was 8.2 minutes. Most participants (70.9%) were gastroenterologists from Institute of Gastroenterology and Hepatology in Iasi Romania. The rest were from academic centers like Bucharest (19.3%) and Timisoara (9.6%). Regarding the understanding of the published EoE guidelines, only 30 respondents (31.6%) were aware that dysphagia and food impaction can be suggestive of EoE and are required diagnostic criteria. All the gastroenterologists agreed that eosinophil-predominant inflammation on esophageal biopsy is a mandatory criterion for EoE diagnosis. The exclusion of secondary causes of esophageal eosinophilia was considered necessary for EoE diagnosis by 42 survey participants (48.3%), while the other gastroenterologists found the differential diagnosis helpful, but optional. The majority agreed to the necessity of a minimum of 6 esophageal biopsies in order to increase the diagnostic yield of EoE, while 16.1% thought a minimum of 2 biopsies to be enough. The preferred first line treatment was proton pump inhibitors (PPI) for 41.9 % and topical steroids for 48.4 % of respondents. Twenty-nine participants (46.8%) considered follow-up with endoscopy and biopsies after a course of 6-12 weeks of therapy in order to evaluate remission, while 22 (35.5%) would not repeat endoscopy in case of symptom resolution. Conclusions: Among gastroenterologists, the adherence of Romanian gastro-enterologists to published EoE guidelines seems to vary considerably, especially regarding PPI use and assessing response to therapy. Targeted strategies are needed to reduce discrepancies in clinical practice, starting with interventions to increase clinical awareness in order to optimize the management of EoE patients.
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