DRIVERS OF VARIATION AMONG PEDIATRIC GASTROENTEROLOGISTS IN DIAGNOSIS AND MANAGEMENT OF EOSINOPHILIC ESOPHAGITIS

Abstract

Background and aims: Widespread variation in the diagnosis and treatment of eosinophilic esophagitis (EoE) has previously been reported among adult gastroenterologists; however, variation in EoE practice in pediatric populations is unknown. The study objective was to describe and understand reasons for variation in diagnosis and management of EoE among pediatric gastroenterologists following publication of the updated 2018 EoE guidelines. Methods: We developed and administered a 28-item survey to pediatric gastroenterologists via email using the PEDGI Bulletin Board from 03/2019-04/2019. 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 only 50% of the total respondents reported adherence. Participants who reported not agreeing with updated guidelines cited concerns regarding insufficient data (23%) increasing number of endoscopies (71%), and misdiagnosing eosinophilia from reflux (56%). Physicians cited that 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.