EoE Down Under Is Still EoE: Variability in Provider Practice Patterns in Australia and New Zealand Among Pediatric Gast
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ORIGINAL ARTICLE
EoE Down Under Is Still EoE: Variability in Provider Practice Patterns in Australia and New Zealand Among Pediatric Gastroenterologists Ajay Sharma1,2,3 · Swathi Eluri4 · Hamish Philpott5 · Daniel A. Lemberg6 · Evan S. Dellon4 Received: 17 May 2020 / Accepted: 3 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background There is likely variation in approach and management of patient with EoE due to lack of standardized care and variation in guidelines. We aimed to identify current practices regarding diagnosis and treatment in children with eosinophillic esophagitis (EoE) in Australia and New Zealand (ANZ). Methods Information on current diagnostic and management approaches for pediatric EoE was collected via an online survey sent to pediatric gastroenterologists (pGE) in ANZ. We performed a cross-sectional study of pGE using a 49-question instrument regarding evaluation, diagnostic, and therapeutic aspects of EoE between October 2019 and December 2019. Results Eighty-five percent of the survey responders were from Australia, and 66% were academic. 30% pGE perform > 3 esophageal biopsies for diagnosis of EoE, 40% involve an allergist, 30% use a twice daily PPI trial, and 70% do not exclude other cause of esophageal eosinophilia. For management, only 3% use dietary elimination as an initial therapy, and 24% use less than the recommended doses of swallowed fluticasone. Forty-nine percent were likely to stop treatment in after remission is achieved for 12 months. The EoE endoscopic reference score (EREFS) was not routinely used (49%). Two-thirds of pGE are concerned about long-term effects of recurrent need of general anesthesia. Conclusions Diagnostic and management strategies for EoE differed widely among pGE in ANZ, including in diagnostic biopsies, assessing competing causes of esophageal eosinophilia, initials selection of treatments, and maintenance strategies. This variability likely reflects continued uncertainty regarding optimal management strategies and stresses the need for pediatric-specific ANZ guidelines to standardize EoE care. Keywords Eosinophilic esophagitis · Variation · Pediatric gastroenterologist
* Ajay Sharma [email protected] 1
Department of Paediatrics, St John of God Hospital, Midland, Perth, Australia
2
Curtin Medical School, Curtin University, Perth, WA, Australia
3
Perth Paediatrics, 5/2 McCourt Street, West Leederville, Perth, WA, Australia
4
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA
5
Northern Adelaide Local Health Network, Department of Gastroenterology, University of Adelaide, Adelaide, SA, Australia
6
Department of Gastroenterology, Sydney Children’s Hospital and School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW, Australia
Abbreviations EoE Eosinophilic esophagitis pGE Pediatric gastroenterologist EREFS Eosinophilic esophagitis
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