PMID- 30715230
OWN - NLM
STAT- MEDLINE
DCOM- 20200103
LR  - 20200225
IS  - 1442-2050 (Electronic)
IS  - 1120-8694 (Print)
IS  - 1120-8694 (Linking)
VI  - 32
IP  - 6
DP  - 2019 Jun 1
TI  - Management of eosinophilic esophagitis is often discordant with guidelines and 
      not patient-centered: results of a survey of gastroenterologists.
LID - 10.1093/dote/doy133 [doi]
LID - doy133
AB  - Published guidelines for the management of eosinophilic esophagitis (EoE) 
      recommend an initial trial of proton pump inhibitors (PPI), histologic assessment 
      for response to therapy, and tailoring treatments to patient needs and provider 
      resources. Effectiveness studies directly comparing therapies are lacking, 
      leaving a situation ripe for shared decision making. We aimed to assess 
      gastroenterologists' adherence to guidelines and how they respond to EoE 
      patients' preferences regarding management. We administered a web-based survey to 
      practicing US gastroenterologists, assessing knowledge, and practice patterns in 
      the management of EoE, including comfort with alternative treatments to steroids. 
      Ninety-two providers responded, including 55% in private practice. Nearly half 
      (47%) reported spending </=10 minutes on initial education and counseling and 48% 
      recommended PPI monotherapy prior to other strategies. Of those who did not start 
      with PPI monotherapy, 55% chose topical steroids +/- PPI and 26% dietary 
      elimination +/- PPI. Despite this, 90% felt comfortable allowing a patient to start 
      dietary elimination instead of steroids, but less comfortable with dilation alone 
      (39%) or no treatment (30%). Upon symptomatic resolution, 72% of academic 
      providers recommended endoscopy with biopsies to demonstrate histologic response 
      to treatment, compared to 27% in private practice. There are substantial 
      variations in adherence to guidelines regarding PPI use and assessing response to 
      therapy. Gastroenterologists prefer topical steroids over other treatment 
      modalities and most spend little time educating and counseling, which may limit 
      informed decision making. Strategies aimed at decreasing these variations in 
      management and promoting shared decision making in EoE are needed.
CI  - (c) The Author(s) 2019. Published by Oxford University Press on behalf of 
      International Society for Diseases of the Esophagus.
FAU - Chang, Joy W
AU  - Chang JW
AD  - Division of Gastroenterology, Department of Internal Medicine, University of 
      Michigan, Ann Arbor, MI.
FAU - Saini, Sameer D
AU  - Saini SD
AD  - Division of Gastroenterology, Department of Internal Medicine, University of 
      Michigan, Ann Arbor, MI.
AD  - Veterans Affairs Center for Clinical Management Research, Ann Arbor VA Medical 
      Center, Ann Arbor, Michigan, USA.
FAU - Mellinger, Jessica L
AU  - Mellinger JL
AD  - Division of Gastroenterology, Department of Internal Medicine, University of 
      Michigan, Ann Arbor, MI.
FAU - Chen, Joan W
AU  - Chen JW
AD  - Division of Gastroenterology, Department of Internal Medicine, University of 
      Michigan, Ann Arbor, MI.
FAU - Zikmund-Fisher, Brian J
AU  - Zikmund-Fisher BJ
AD  - Division of General Medicine, Department of Internal Medicine, University of 
      Michigan, Ann Arbor, MI.
AD  - Department of Health Behavior and Health Education, University of Michigan, Ann 
      Arbor, MI.
FAU - Rubenstein, Joel H
AU  - Rubenstein JH
AD  - Division of Gastroenterology, Department of Internal Medicine, University of 
      Michigan, Ann Arbor, MI.
AD  - Veterans Affairs Center for Clinical Management Research, Ann Arbor VA Medical 
      Center, Ann Arbor, Michigan, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Dis Esophagus
JT  - Diseases of the esophagus : official journal of the International Society for 
      Diseases of the Esophagus
JID - 8809160
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Steroids)
SB  - IM
MH  - Biopsy
MH  - Decision Making, Shared
MH  - Dilatation
MH  - Directive Counseling
MH  - Eosinophilic Esophagitis/diet therapy/*pathology/*therapy
MH  - Esophageal Mucosa/pathology
MH  - Female
MH  - Gastroenterology/*standards/*statistics & numerical data
MH  - Guideline Adherence/*statistics & numerical data
MH  - Health Knowledge, Attitudes, Practice
MH  - Humans
MH  - Male
MH  - Patient Education as Topic/statistics & numerical data
MH  - Patient Preference
MH  - Patient-Centered Care
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Private Practice/statistics & numerical data
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Steroids/therapeutic use
MH  - Surveys and Questionnaires
PMC - PMC6561423
OTO - NOTNLM
OT  - decisions
OT  - disease management
OT  - guidelines
OT  - practice patterns
OT  - preference
OT  - providers
EDAT- 2019/02/05 06:00
MHDA- 2020/01/04 06:00
PMCR- 2020/01/31
CRDT- 2019/02/05 06:00
PHST- 2018/12/19 00:00 [accepted]
PHST- 2018/10/12 00:00 [received]
PHST- 2018/12/11 00:00 [revised]
PHST- 2019/02/05 06:00 [pubmed]
PHST- 2020/01/04 06:00 [medline]
PHST- 2019/02/05 06:00 [entrez]
PHST- 2020/01/31 00:00 [pmc-release]
AID - 5304730 [pii]
AID - doy133 [pii]
AID - 10.1093/dote/doy133 [doi]
PST - ppublish
SO  - Dis Esophagus. 2019 Jun 1;32(6):doy133. doi: 10.1093/dote/doy133.