Vermeulen B D, Bogte A, Verhagen M A, Pullens H J M, Siersema P D
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht.
Dis Esophagus. 2018 Feb 1;31(2). doi: 10.1093/dote/dox119.
In recent years, new guidelines and recommendations have been published regarding the diagnostic criteria and therapeutic management of eosinophilic esophagitis (EoE). The aim of this study is to assess the diagnostic and therapeutic management of patients diagnosed with EoE in daily clinical practice and whether this was performed according to current guidelines and recommendations. A population-based, multicenter retrospective cohort study was conducted using data from the national pathology registry (PALGA), medical records, and telephone interviews of patients diagnosed with EoE in two academic and two nonacademic hospitals in the period 2004 to 2014. The study was approved by all involved ethical committees. Data regarding demographics, clinical manifestations, endoscopic results, histologic samples, and therapeutic strategies were collected. Standard statistical analyses were performed to summarize patient characteristics. We included 119 patients diagnosed with EoE in this study. The median age at onset of symptoms was 29 years (IQR: 15-42) and the median age at diagnosis was 38 years (IQR: 23-51 years), leading to a median diagnostic patients' delay of 6.5 years (IQR: 2-14 years). The median physicians' delay in diagnosis between first contact in the hospital and diagnosis was 1.0 year (IQR: 1-7 years). The incidence of newly diagnosed patients with EoE increased steadily over a period of 11 years. Criteria for the microscopic diagnosis of EoE varied between pathologists in each hospital. Initial treatment included topical corticosteroids (TCS) (30.3%), proton pump inhibitors (PPI) (29.4%), or a combination (10.1%). A follow-up endoscopy was performed in 40.3% of patients. During follow-up, treatment included PPIs (76.0%), TCS (59.6%), a combination of PPIs and TCS (45.4%), and endoscopic dilations (6.7%). Diagnostic and therapeutic discrepancies between daily clinical practice and recommendations from current and past guidelines were observed. Apart from developing guidelines, efforts should be undertaken to implement these in daily clinical practice.
近年来，已发布了关于嗜酸性粒细胞性食管炎（EoE）诊断标准和治疗管理的新指南及建议。本研究的目的是评估日常临床实践中确诊为EoE的患者的诊断和治疗管理情况，以及其是否按照当前指南和建议进行。利用国家病理登记处（PALGA）的数据、病历以及对2004年至2014年期间在两家学术医院和两家非学术医院确诊为EoE的患者进行的电话访谈，开展了一项基于人群的多中心回顾性队列研究。该研究获得了所有相关伦理委员会的批准。收集了有关人口统计学、临床表现、内镜检查结果、组织学样本和治疗策略的数据。进行了标准统计分析以总结患者特征。本研究纳入了119例确诊为EoE的患者。症状出现的中位年龄为29岁（四分位间距：15 - 42岁），诊断时的中位年龄为38岁（四分位间距：23 - 51岁），导致患者诊断延迟的中位时间为6.5年（四分位间距：2 - 14年）。从首次到医院就诊至诊断之间医生诊断延迟的中位时间为1.0年（四分位间距：1 - 7年）。在11年期间，新确诊的EoE患者发病率稳步上升。各医院病理学家对EoE的微观诊断标准各不相同。初始治疗包括局部使用皮质类固醇（TCS）（3 . 3%）、质子泵抑制剂（PPI）（29. . 4%）或联合使用（10.1%）。40.3%的患者进行了随访内镜检查。在随访期间，治疗包括PPI（76.0%）、TCS（59.6%）、PPI和TCS联合使用（45.4%）以及内镜扩张（6.7%）。观察到日常临床实践与当前及过去指南建议之间存在诊断和治疗差异。除了制定指南外，还应努力在日常临床实践中实施这些指南。
