Al-Hussaini Abdulrahman, Alrashidi Jaber, Miqdady Mohamad, Bitar Rana, AlFayyad Isamme
Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Front Pediatr. 2025 Apr 10;13:1521266. doi: 10.3389/fped.2025.1521266. eCollection 2025.
The practice patterns of eosinophilic esophagitis (EoE) remain poorly characterized. Few studies investigated the variability of clinical patterns among gastroenterologists, mainly in the United States.
We assessed the practice patterns of gastroenterologists in the Arab countries regarding the diagnosis and management of EoE, and their concordance with the European 2017 guidelines and the Proceedings of the AGREE Conference published in 2018.
We conducted a cross-sectional, self-administered, online survey of practicing gastroenterologists in the Arab countries (April to December 2022). The survey consisted of 23 questions and was designed to assess the respondents' practice characteristics, knowledge and practice on diagnosis and treatment of EoE.
A total of 190 participants responded to the survey (118 pediatric gastroenterologists and 72 adult gastroenterologists). Thirty-six percent and 31% saw ≥6 new patients with EoE annually, 55% were 'very familiar' with the most recent EoE guidelines, and 49% attended ≥3 E-E-related educational activities during the 3 years prior to the survey. The majority of the respondents (72%) did not require a trial of a proton-pump inhibitor (PPI) prior to making the diagnosis of EoE and 66% obtain biopsies from multiple esophageal levels. While 90% of the respondents considered eosinophil-predominant inflammation on esophageal biopsies necessary for the diagnosis of EoE, only 27% felt that symptoms of esophageal dysfunction are necessary for the diagnosis, and only half of the participants considered exclusion of other etiologies of esophageal eosinophilia necessary for the diagnosis of EoE. For first-line treatment, only 16% used PPI monotherapy, 12.6% topical steroids, and 63.5% treat with a variable combination of PPIs, topical steroids, and dietary elimination. Sixty percent would repeat upper endoscopy to determine histologic improvement and 72% use maintenance therapy in responders. Compared to pediatric gastroenterologists, significantly fewer adult gastroenterologists reported taking biopsies from proximal and distal esophagus (34% vs. 66%) and gastric and duodenal biopsies (67% vs. 90%) when EoE was suspected ( < 0.001).
There is significant variability in adherence to EoE guidelines among gastroenterologists in the Arab countries. Our results highlight areas of need for continuous education and form the basis to assess implementation efforts in the future.
嗜酸性食管炎（EoE）的临床实践模式仍未得到充分描述。很少有研究调查胃肠病学家之间临床模式的差异，主要是在美国。
我们评估了阿拉伯国家胃肠病学家在EoE诊断和管理方面的实践模式，以及他们与2017年欧洲指南和2018年发表的AGREE会议论文集的一致性。
我们对阿拉伯国家的执业胃肠病学家进行了一项横断面、自我管理的在线调查（2022年4月至12月）。该调查由23个问题组成，旨在评估受访者的实践特征、EoE诊断和治疗的知识及实践。
共有190名参与者回复了调查（118名儿科胃肠病学家和72名成人胃肠病学家）。36%和31%的人每年诊治≥6例新的EoE患者，55%的人“非常熟悉”最新的EoE指南，49%的人在调查前3年内参加了≥3次与EoE相关的教育活动。大多数受访者（72%）在诊断EoE之前不需要试用质子泵抑制剂（PPI），66%的人从多个食管水平获取活检样本。虽然90%的受访者认为食管活检中嗜酸性粒细胞为主的炎症是EoE诊断所必需的，但只有27%的人认为食管功能障碍症状是诊断所必需的，只有一半的参与者认为排除食管嗜酸性粒细胞增多的其他病因是EoE诊断所必需的。对于一线治疗，只有16%的人使用PPI单一疗法，12.6%的人使用局部类固醇，63.5%的人采用PPI、局部类固醇和饮食排除的不同组合进行治疗。60%的人会重复进行上消化道内镜检查以确定组织学改善情况，72%的人对有反应者使用维持治疗。与儿科胃肠病学家相比，怀疑患有EoE时，报告从食管近端和远端进行活检（34%对66%）以及进行胃和十二指肠活检（67%对90%）的成人胃肠病学家明显较少（<0.001）。
阿拉伯国家的胃肠病学家在遵循EoE指南方面存在显著差异。我们的结果突出了持续教育的需求领域，并为未来评估实施工作奠定了基础。
