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

  • Miller, Talya L1
  • Desai, Arti D2, 3
  • Garrison, Michelle M3, 4
  • Lee, Dale2
  • Muir, Amanda5
  • Lion, K Casey2, 3
  • 1 Department of Pediatrics, University of North Carolina, 101 Manning Drive, N.C. Children's Hospital, Ground Floor, Chapel Hill, NC, 27514, USA. [email protected]
  • 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.
  • 3 Seattle Children's Research Institute, M/S CS8-6, 2001 Eighth Ave, PO BOX 5371, Seattle, WA, 98121, USA.
  • 4 Department of Health Services, University of Washington, M/S CS8-6, 2001 Eighth Ave, PO BOX 5371, Seattle, WA, 98121, USA.
  • 5 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.
Published Article
Digestive Diseases and Sciences
Publication Date
Jun 01, 2022
DOI: 10.1007/s10620-021-07039-6
PMID: 33974186


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. 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. 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. 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. © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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