Dietary Therapy for Eosinophilic Esophagitis Unpopular Among Gastroenterologists

Recent studies have demonstrated that dietary elimination therapy is an effective nonprescription treatment for eosinophilic esophagitis (EoE), yet many providers are still hesitant about recommending dietary therapy to patients and choose to use medication treatments instead. 

This cross-sectional online survey included 2 cohorts of gastroenterologists: a primary cohort (n=94) and a secondary validation cohort (n=195). The primary cohort was recruited from various gastroenterological societies and organizations, and the second group was recruited from Medscape. The survey, given over a 6-month period from 2021 to 2022, consisted of 20 questions regarding beliefs and practices while treating patients with EoE. 

On a scale from 0% to 100%, gastroenterologists gave diet as an effective short-term treatment a rating of 46.8% (standard deviation [SD], 31.2), lower than both topical corticosteroids (74.3%; SD, 29.8; P=0) and proton pump inhibitors (56.5%; SD, 26.8; P=.062). For long-term treatment, the mean efficacy rating of dietary therapy increased (49.5%; SD, 38.9), but gastroenterologists still rated dietary therapy lower than topical corticosteroids (64.4%; SD, 31.6; P=.012) and similar to proton pump inhibitors (53.3%; SD, 27.4; P=.72). The major barrier reported for dietary therapy was the provider’s belief that patients are not interested in this type of treatment (58%). The study also reported that many providers, specifically those in nonacademic settings, do not have easy access to dieticians to assist in this treatment option (56% with access in nonacademic settings vs 85% in academic settings).