Department of Pediatrics, University of North Carolina, 101 Manning Drive, N.C. Children's Hospital, Ground Floor, Chapel Hill, NC, 27514, USA.
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.
Dig Dis Sci. 2022 Jun;67(6):2029-2038. doi: 10.1007/s10620-021-07039-6. Epub 2021 May 11.
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.
先前有研究报道，成人胃肠病学家在嗜酸细胞性食管炎（EoE）的诊断和治疗方面存在广泛的差异；然而，儿科人群中 EoE 治疗实践的差异特征描述较差。本研究的目的是描述在更新的 2018 年国际 EoE 指南发布后，遵循该指南的情况下，儿科胃肠病学家对 EoE 实践的遵从情况，并了解其中差异的原因。
我们使用 PEDGI 公告板通过电子邮件列表服务向儿科胃肠病学家开发和提供了一项包含 28 个问题的调查，调查的开发基于循证审查、专家验证和认知访谈。调查的领域包括受访者对已发表指南的了解和遵从程度、诊断和管理方法及依据，以及参与者的人口统计学。分析包括描述性统计和关联检验。
共有 288 名儿科胃肠病学家完成了调查，其中大多数人在学术中心工作（73%）。超过一半（63%）的人表示了解 2018 年更新的指南；然而，只有 52%的人同意这些指南，50%的人报告遵守这些指南。报告不同意更新指南的受访者提出了对增加内镜检查数量（72%）、从反流中误诊嗜酸粒细胞（56%）以及数据不足（23%）的担忧。在选择治疗方法时，最常见的决策驱动因素是患者/家属的偏好、证据/指南和症状负担。
许多医生不遵守当前的指南，原因包括对更新指南缺乏了解，以及对支持证据的强度的担忧。本研究阐明了几个需要加强这些指南教育的领域，以促进广泛的遵从。
