Introduction: Physicians prefer to use medications for eosinophilic esophagitis (EoE) even though elimination diet is an effective treatment with growing interest among patients. The beliefs, practices, and barriers that surround this clinical practice are unknown. We aimed to describe provider practice patterns around dietary approaches in EoE, and identify beliefs about, perceived barriers and needed resources to support diet therapy.
Methods: We conducted a cross-sectional web-based survey of providers to assess the perceived effectiveness and barriers to starting dietary therapy, as well as practice patterns.
Results: Respondents included a primary cohort of gastroenterologists (n=94) recruited from professional societies and a secondary validation cohort of Medscape provider members (n=195; 76.9% gastroenterology, 23.1% allergy) with comparable spread across various practice settings, geographic regions, and access to dietitian support. Dietary therapy was viewed as the least effective short (46.8%, p ≤ 0.01) and long-term (49.5%) treatment compared with topical corticosteroids (74.3%) and proton pump inhibitors (56.5%). The greatest barrier to recommending or starting diets in EoE was the perception that patients are not interested in, unlikely to accept, or adhere to diet therapy (58%). In contrast, few providers (14%) felt that their own lack of knowledge and experience in the diet was a barrier. While the majority of providers reported that dietitians should be primarily responsible for diet-focused education, private practice providers have less access to dietitians (55.6% vs 84.6%, p ≤ 0.05) and are more likely try to manage dietary therapy alone compared to providers in academic centers.
Discussion: Providers often lack dietitian support and prefer using medications because of a perceived lower efficacy and beliefs about patient acceptance and adherence to dietary therapy. With growing evidence that patients with EoE do accept dietary therapies and value shared decision making in electing treatments, our findings highlight discordances between provider and patient preferences, incomplete communication, and potentially unrecognized provider knowledge gaps. Given the dearth of approved medications for EoE, educating providers with evidence-based knowledge about non-pharmacologic options, understanding patient views and preferences for treatment, and improving dietitian-led education are essential in providing high-quality EoE care.
.jpg "Joy W. Chang, MD, MS photo")