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Drivers of Variation in Diagnosis and Management of Eosinophilic Esophagitis: A Survey of Pediatric Gastroenterologists

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Abstract

Background

Widespread variation in the diagnosis and treatment of eosinophilic esophagitis (EoE) has previously been reported among adult gastroenterologists; however, variation in EoE practice in among pediatric populations is poorly characterized. The study objectives were to describe guideline adherence and understand reasons for variation in EoE practice among pediatric gastroenterologists following publication of the updated 2018 international EoE guidelines.

Methods

We developed and administered a 28-item survey to pediatric gastroenterologists via an email listserv using the PEDGI Bulletin Board from 03/2019 to 04/2019. The survey was developed using evidence-based review, expert validation, and cognitive interviews. Survey domains included respondent knowledge of and adherence to published guidelines, diagnostic and management approach and rationale, and participant demographics. Analysis included descriptive statistics and tests for association.

Results

A total of 288 pediatric gastroenterologists completed the survey, most of whom practiced in an academic center (73%). More than half (63%) reported knowledge of the 2018 updated guidelines; however, only 52% agreed with them and 50% reported adherence. Respondents who reported not agreeing with updated guidelines cited concerns regarding increasing number of endoscopies (72%), misdiagnosing eosinophilia from reflux (56%), and insufficient data (23%). The most common drivers of decision making with respect to therapy choice were patient/family preference, evidence/guidelines, and symptom burden.

Conclusions

Many physicians are not adherent to current guidelines for reasons which include lack of knowledge of updated guidelines and concern regarding the strength of the supporting evidence. This study elucidates several areas to enhance education regarding these guidelines to promote widespread adherence.

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Abbreviations

EoE:

Eosinophilic esophagitis

PPI:

Proton pump inhibitor

NASPGHAN:

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

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Funding

The study was conducted under funding from Seattle Children’s Hospital and the University of Washington. Dr. Desai’s effort is supported by Grant No. K08HS024299 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of Seattle Children’s Hospital, the University of Washington or the Agency for Healthcare Research and Quality. The sponsors had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Study data were collected and managed using REDCap electronic data capture tools [34] hosted at the Institute of Translational Health Sciences. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources. REDCap at ITHS is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award No. UL1 TR002319.

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Authors and Affiliations

  1. Department of Pediatrics, University of North Carolina, 101 Manning Drive, N.C. Children’s Hospital, Ground Floor, Chapel Hill, NC, 27514, USA

    Talya L. Miller

  2. Department of Pediatrics, University of Washington/Seattle Children’s Hospital, 4800 Sand Point Way NE, OB.9.620.1-Gastroenterology and Hepatology, Seattle, WA, 98105, USA

    Arti D. Desai, Dale Lee & K. Casey Lion

  3. Seattle Children’s Research Institute, M/S CS8-6, 2001 Eighth Ave, PO BOX 5371, Seattle, WA, 98121, USA

    Arti D. Desai, Michelle M. Garrison & K. Casey Lion

  4. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Amanda Muir

  5. Department of Health Services, University of Washington, M/S CS8-6, 2001 Eighth Ave, PO BOX 5371, Seattle, WA, 98121, USA

    Michelle M. Garrison

Authors
  1. Talya L. Miller
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  4. Dale Lee
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  6. K. Casey Lion
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Contributions

Dr. Miller conceptualized and designed the study, conducted the data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Lee and Muir participated in the design of the study, participated in the data analysis, and reviewed and revised the manuscript. Dr. Desai participated in the design of the study, participated in interpretation of the data, and reviewed and revised the manuscript. Drs. Desai, Garrison and Lion participated in the design of the study, participated in the data analysis, participated in interpretation of the data, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Talya L. Miller.

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Miller, T.L., Desai, A.D., Garrison, M.M. et al. Drivers of Variation in Diagnosis and Management of Eosinophilic Esophagitis: A Survey of Pediatric Gastroenterologists. Dig Dis Sci 67, 2029–2038 (2022). https://doi.org/10.1007/s10620-021-07039-6

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