OC10 Baseline survey on the management of paediatric eosinophilic oesophagitis in the UK and Ireland from the BSPGHAN EoE working group (2024)

The BSPGHAN eosinophilic oesophagitis working group (EoE-WG) was established in 2020, and identified heterogeneity in the management of paediatric EoE. BSG/BSPGHAN consensus guidelines for EoE in children and adults were published in 2022.¹ This baseline survey was conducted between March 2021 and December 2022 by the EoE-WG, with 45 respondents from 33 paediatric centres in the UK and Ireland. The survey explored clinical presentation, diagnostic approaches, treatment modalities, monitoring and service setups used by clinicians managing this condition.

Dysphagia and bolus impaction emerged as prominent symptoms, with around a third of respondents highlighting increased liquid intake during meals and slow eating/prolonged chewing as important behaviours. In children with limited language, distress during feeding, food aversion, vomiting/regurgitation, and weight loss/failure to thrive were prevalent. The majority of patients were diagnosed within a year of symptom onset, although children at some centres took up to five years. The median age at diagnosis was 10 years. Common comorbidities include asthma, eczema, and allergies, aligning with expectations. Surprisingly, whereas three-quarters of patients had asthma as a comorbidity, only a quarter of clinicians identified it as a risk factor for EoE. Tracheo-oesophageal fistula exhibited a relatively high co-existence, prompting consideration for further prevalence data collection.

Oesophagogastroduodenoscopy (OGD) was performed by 93% of responding clinicians. While duodenal biopsies were universally taken, the approach to oesophageal biopsies differed among clinicians, with most taking six biopsies from three oesophageal levels. The number of biopsies varied based on disease probability and practical considerations. Some centres found that two biopsies at each level showed good agreement on EoE features.

A majority of clinicians use histology for description of disease activity (71%), with endoscopic appearance being equally used to grade EoE severity (73%). Contrast swallows were commonly requested in cases of dysphagia or suspected mechanical obstruction, while impedance measurement was used in reflux-related symptoms. Few clinicians opted for additional tests.

Disease severity, protocols, and patient preference were the primary factors influencing the selection of first-line treatment. PPIs were the preferred medical therapy across all age groups (91%). Topical steroids were used as second most common treatment (69%, increasing to 82% as second-line treatment). Exclusion diets were more used by 62% of clinicians (more commonly in younger children). Approximately 36% of clinicians had not encountered stricturing disease. Dilatation (often in consultation with surgeons or radiologists) was favoured as first-line treatment for strictures, followed by topical steroids. PPIs and exclusion diets were less commonly chosen.

Most clinicians reviewed treatment at three months, relying on clinician-initiated symptom reviews and histology. Most clinicians (93%) did not use EoE quality of life scoring systems. The majority of clinicians expressed a preference for re-scoping (73% with, versus 87% without clinical improvement, although they also highlighted limited endoscopy capacity.

This survey provides valuable insights into the current practices in the management of EoE, highlighting variations in diagnostic and treatment approaches. The findings underscore the need for education, training, funded research and standardisation in the management of this chronic condition.

References

1. Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022; doi:10.1136/gutjnl-2022–327326

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