Challenges in Managing Patients Referred to the Allergy Clinic for Eosinophilic Esophagitis
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Samantha K. Lin, MD, Neelu Kalra, MD, Gisoo Ghaffari, MD FAAAAI
RATIONALE: Eosinophilic esophagitis (EoE) can be difficult to manage for a variety of reasons, including overlaps in presentation with gastroesophageal reflux disease and proton pump inhibitor responsive eosinophilia, uncertainties regarding the role of different forms of allergy testing, and a variety of patient adherence issues. We sought to objectively study the challenges faced when managing EoE.

METHODS: We conducted a telephone survey of 78 patients (pediatric and adult) who were referred to our academic allergy clinic for EoE (all had biopsies with ≥15 eos/hpf). The survey obtained patients’ perspectives regarding treatments used. We then conducted a chart review to determine if there had been an appropriate proton pump inhibitor (PPI) trial prior to diagnosis, and we compared patient responses with documented allergy test results, treatment plans, and biopsy results.

RESULTS: Only 22/78 patients (28%) had an appropriate PPI trial prior to diagnosis/referral. There was considerable variability in the type of allergy testing done, and in how the results were used to guide therapy. Over 1/3 of patients reported being on a different treatment regimen (PPI, swallowed steroid, and/or diet) than we had recommended, and over 1/3 of patients reported being on a diet that did not match our recommendations. Finally, nearly half of adult patients failed to have follow up biopsies done despite recommendations for this.

CONCLUSIONS: We identify several challenges in EoE management, including potential misdiagnosis, lack of standardization in testing/treatment, and patient adherence issues. We hope this information will prompt increased vigilance for these issues and promote further research where still needed.