Clinical practices and adherence to guidelines for eosinophilic esophagitis: A European survey

Andrea Sorge; Marina Coletta; Luca Elli; Albert J Bredenoord

doi:10.1016/j.dld.2023.12.011

Clinical practices and adherence to guidelines for eosinophilic esophagitis: A European survey

Dig Liver Dis. 2024 Jan 29:S1590-8658(23)01118-0. doi: 10.1016/j.dld.2023.12.011. Online ahead of print.

Authors

Andrea Sorge¹, Marina Coletta², Luca Elli², Albert J Bredenoord³

Affiliations

¹ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. Electronic address: andreasorge6@gmail.com.
² Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
³ Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands.

PMID: 38290961
DOI: 10.1016/j.dld.2023.12.011

Abstract

Background: We aimed to assess the clinical practices and adherence to guidelines for adult Eosinophilic Esophagitis (EoE) patients in Europe.

Methods: A cross-sectional web survey containing 23 questions was distributed to members of the European Consortium for Eosinophilic Diseases of the Gastrointestinal Tract (EUREOS) and the Italian Association of Hospital Gastroenterologists and digestive endoscopists (AIGO). We conducted a subgroup analysis to assess the impact of EoE expertise and practice setting on clinical practices.

Results: 228 physicians from 18 European countries participated. Adherence to guidelines varied from 72% to 98.6%. 83.4% of total respondents obtained ≥ 6 esophageal biopsies in suspected EoE. 42% of total respondents, 82.5% of EoE experts (vs. non-experts 33%; P < 0.0001), and 55% of academics (vs. 29.1 non-academics; P < 0.0001) routinely used the EREFS score. Regarding first-line therapy, 82.9% of total respondents prescribed proton pump inhibitors, 41.6% topical steroids, 20.6% elimination diets, and 9.2% combination therapies. Only 72% of respondents used symptoms and endoscopy with <15 Eosinophils/HPF to define treatment response. 21.5% of all respondents did not prescribe maintenance therapies and 12.7% discontinued therapy before response evaluation endoscopy.

Conclusion: Our findings revealed significant heterogeneity in practice patterns and suboptimal adherence to EoE guidelines across Europe. Expertise in EoE and working in an academic hospital positively influenced clinical practices and adherence to guidelines.

Keywords: Adherence to EoE guidelines in Europe; Adherence to guidelines for eosinophilic esophagitis; Eosinophilic esophagitis clinical practices; European survey on EoE.