Diagnosis and Treatment Strategies of Eosinophilic Esophagitis: A Nationwide Survey

Background/Objectives: Eosinophilic esophagitis (EoE) is an increasingly recognized chronic immune-mediated inflammatory disease of the esophagus. Data on the real-world diagnosis and management practices among gastroenterologists in Israel is scarce. This study aimed to describe current diagnostic and treatment practice patterns for eosinophilic esophagitis among Israeli gastroenterologists, and to identify areas of concordance with, and variability relative to, international recommendations. Methods: A nationwide, cross-sectional, internet-based survey was conducted among gastroenterologists from the Israeli Gastroenterology Association (IGA) and the Israeli Society of Pediatric Gastroenterology, Hepatology and Nutrition between February and April 2024. We used a structured 28-item questionnaire covering physician demographics, diagnostic practices and treatment strategies of EoE. Responses were analyzed for the entire cohort and compared across subgroups based on physician characteristics. Results: Of the 540 eligible gastroenterologists, 114 (22%) completed the survey. Almost all responders (97%) would obtain esophageal biopsies in the case of dysphagia even without typical endoscopic findings. Similarly, 94% of the responders would obtain esophageal biopsies in the case of typical endoscopic findings even without dysphagia. About 86 (75%) were familiar with the Endoscopic Reference Score (EREFS) system. Proton pump inhibitors were the most prescribed first-line treatment (92%), followed by dietary interventions (40%) and topical steroids (17%). As compared with adult gastroenterologists, pediatric gastroenterologists were more likely to obtain biopsies, use the EREFS and initiate treatment before histologic confirmation was obtained. Overall, practices showed broad concordance with international recommendations (>75% of respondents). Conclusions: In this cross-sectional survey, it was demonstrated that diagnostic and treatment practices for EoE among Israeli gastroenterologists were broadly concordant with international recommendations. However, several areas of inconsistency across different provider subgroups were identified. These gaps can be managed through educational programs that will improve standardization of management in EoE.