Division of Pediatric Gastroenterology, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA.
Dig Dis Sci. 2010 Apr;55(4):973-82. doi: 10.1007/s10620-009-0801-9. Epub 2009 Apr 24.
To survey pediatric (PGI) and adult gastroenterologists (AGI) regarding their perceptions about the etiology, diagnosis, and management of eosinophilic esophagitis (EoE), and to assess whether differences in the clinical approach to EoE exist between these subspecialists. A 21-item survey related to EoE was emailed to PGI who subscribe to the PEDSGI Bulletin Board, and to two AGI per Electoral College vote in the US, randomly selected from each state. The survey was voluntary, and consent was assumed based on survey submission. The responses were submitted anonymously and results compiled in a secure Web site. A total of 249 physicians from across the globe responded to the survey, 68% of whom were PGI. The majority of respondents worked primarily in an academic institution or teaching hospital. Respondents revealed diagnosing an average of six cases (median 8, range 0-30) of EoE in the past 6 months. Ninety-two percent of AGI who see a patient with dysphagia and suspected EoE proceed to endoscopy with biopsies, compared to only 54% of PGI (P < 0.05); 38% of PGI would first perform an upper GI study. Both subspecialties agreed that biopsies of the proximal and distal esophagus are needed to make a definitive diagnosis of EoE. Fifty-eight percent PGI and 44% AGI defined EoE as an eosinophilic density of > or =20 per high power field (hpf) in esophageal biopsies. Seventy-seven percent of PGI but only 16% of AGI reported routine referral of patients for food allergy evaluation (P < 0.05). While 77% PGI and 91% of AGI would rely on a symptom-based follow-up, 27% PGI versus 9% AGI follow patients with biopsies according to a pre-determined schedule and another 38% repeat biopsies as needed, versus 15% AGI. This survey exposes a few inconsistencies among gastroenterologists in the diagnosis, management, and follow-up of patients with EoE. The currently available practice guidelines for the diagnosis and management of EoE are largely based on retrospective studies and expert opinion. The results of this survey suggest that a collaborative effort based on robust research is required upon us to develop evidence for how we care for these patients.
调查儿科（PGI）和成人胃肠病学家（AGI）对嗜酸性食管炎（EoE）病因、诊断和治疗的看法，并评估这些专家在 EoE 临床处理方法上是否存在差异。向订阅 PEDSGI 公告板的 PGI 以及美国每州随机选择的每位选举团投票的两名 AGI 发送了一份与 EoE 相关的 21 项调查。该调查是自愿的，并且假设基于调查提交即同意。调查结果匿名提交，并在安全的网站上汇总。来自全球各地的 249 名医生对该调查做出了回应，其中 68%是 PGI。大多数受访者主要在学术机构或教学医院工作。受访者报告称，在过去 6 个月中平均诊断了 6 例（中位数为 8，范围为 0-30）EoE。92%的 AGI 看到有吞咽困难和疑似 EoE 的患者会进行内镜检查和活检，而只有 54%的 PGI（P <0.05）；38%的 PGI 会首先进行上消化道研究。两个专业都认为需要对食管近端和远端进行活检以明确诊断 EoE。58%的 PGI 和 44%的 AGI 将 EoE 定义为食管活检中每高倍镜视野（hpf）嗜酸性粒细胞密度≥20。77%的 PGI 但只有 16%的 AGI 报告常规转介患者进行食物过敏评估（P <0.05）。尽管 77%的 PGI 和 91%的 AGI 会依赖基于症状的随访，但 27%的 PGI 与 9%的 AGI 会根据预定计划随访活检患者，另有 38%会根据需要重复活检，而 AGI 只有 15%。这项调查揭示了胃肠病学家在诊断、治疗和随访 EoE 患者方面存在一些不一致之处。目前 EoE 的诊断和管理指南主要基于回顾性研究和专家意见。该调查结果表明，我们需要基于强有力的研究进行合作努力，为我们如何照顾这些患者制定证据。
