Management of suspected and known eosinophilic esophagitis-a nationwide survey in Austria

Wien Klin Wochenschr. 2023 Aug;135(15-16):406-413. doi: 10.1007/s00508-023-02198-0. Epub 2023 Apr 18.

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus with increasing incidence and dysphagia as the main symptom. The management of suspected or known EoE by Austrian endoscopists has not been investigated yet.

Methods: A web-based survey with 13 questions about the management of EoE was sent to endoscopists via the Austrian Society of Gastroenterology and Hepatology (ÖGGH).

Results: A total of 222 endoscopists (74% gastroenterologists, 23% surgeons, and 2% pediatricians; 68% working in a hospital) from all 9 states participated. In patients with dysphagia but a normal appearing esophagus, 85% of respondents reported always taking biopsies; however, surgeons were less likely to obtain biopsies compared to gastroenterologists ("always" 69% vs. 90%, "sometimes" 29% vs. 10%, "never" 2% vs. 0%, p < 0.001). The approved budesonide orodispersible tablet is the preferred first-line drug used in EoE, ahead of proton pump inhibitors (PPI). Only 65% of participants monitor the patients by endoscopy and histology after 12 weeks of induction therapy, 26% do not continue maintenance therapy, and 22% monitor patients only when symptomatic.

Conclusion: The vast majority of Austrian endoscopists adhere to the European and US guidelines in cases of suspected EoE. In contrast, despite the chronic disease course, a significant percentage of providers indicate not to use maintenance therapy and monitor the patients routinely.

Keywords: Dysphagia; Esophageal Disease; Esophageal Food Impaction; Inflammatory Bowel Disease; Swallowing Disorder.

MeSH terms

  • Austria
  • Deglutition Disorders* / drug therapy
  • Deglutition Disorders* / etiology
  • Eosinophilic Esophagitis* / diagnosis
  • Eosinophilic Esophagitis* / epidemiology
  • Eosinophilic Esophagitis* / therapy
  • Humans
  • Proton Pump Inhibitors / therapeutic use
  • Surveys and Questionnaires

Substances

  • Proton Pump Inhibitors

Supplementary concepts

  • Eosinophilic enteropathy