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

Abstract

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.

Zusammenfassung

Hintergrund Die eosinophile Ösophagitis (EoE) ist eine zunehmend häufig erkannte, immunvermittelte Erkrankung der Speiseröhre und eine der häufigsten Ursachen für Dysphagie und Bolusobstruktionen. Ziel dieser Umfrage war es, das gegenwärtige klinische Management der EoE unter Gastroenterologen in Deutschland zu untersuchen.

Methodik Wir führten eine Querschnittsstudie unter 1393 Gastroenterologen (bng, ALGK) mittels eines Fragebogens durch, der 22 Fragen zu allgemeinen, diagnostischen und therapeutischen Aspekten der EoE enthielt. Die online-Umfrage erfolgte zwischen November 2017 und Februar 2018. Die Daten wurden mittels SurveyMonkey erfasst und analysiert.

Ergebnisse Die Responderrate betrug 29,6 %. Mehr als die Hälfte der Responder (54,9 %) gaben an, eine signifikante Zunahme von EoE-Patienten zu beobachten. Der EREFS-Score war in der Mehrzahl entweder unbekannt (44,3 %) oder wird in der Routine nicht verwendet (52,2 %). Bei Verdacht auf EoE entnahmen die Mehrzahl multiple Ösophagusbiopsien (n = 3 – 4: 35,7 %, n > 4: 61,6 %). Die bevorzugte Initialtherapie waren PPI (37,2 %) oder topische Steroide (35 %). Die PPI-Regime waren sehr divers. Nur in der Hälfte der Fälle wurde eine hochdosierte PPI-Therapie durchgeführt. Eine Allergietestung wurde häufig veranlasst (immer: 25,4 %, manchmal: 48,9 %). Die häufigste dietätische Therapie war die 6-Food-Eliminationsdiät (52 %), gefolgt von der Allergietest-gesteuerten Diät (16 %) und der 2-Food-Eliminationsdiät (16 %). Die Mehrzahl der Responder sahen die Notwendigkeit einer Langzeittherapie (in > 50 % der Patienten: 23 %, in 25 – 50 % der Patienten: 47,7 %).

Schlussfolgerung Unter Gastroenterologen in Deutschland gibt es eine substantielle Variation in der Adhärenz zu publizierten Leitlinien der EoE. Dieser Befund unterstreicht die Notwendigkeit einer intensiveren Fortbildung und einer nationalen Leitlinie, um eine Optimierung und Harmonisierung in der klinischen Versorgung von EoE-Patienten sicherzustellen.

Key words

eosinophilic esophagitis - dysphagia - bolus obstruction - proton pump inhibitor - corticosteroids - elimination diet - endoscopic therapy

Schlüsselwörter

Eosinophile Ösophagitis - Diagnose - Therapie - Dysphagie

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