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Gastroenterology Practice Patterns Contribute to Missed Diagnoses of Eosinophilic Gastritis and Duodenitis

Open AccessPublished:November 24, 2022DOI:https://doi.org/10.1016/j.gastha.2022.11.010
Gastroenterology Practice Patterns Contribute to Missed Diagnoses of Eosinophilic Gastritis and Duodenitis
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      ABSTRACT

      Background and Aims

      Eosinophilic gastritis and eosinophilic duodenitis (EoG/EoD) are often misdiagnosed as functional gastrointestinal disorders. Consequently, patients with gastrointestinal symptoms of EoG/EoD may not undergo the necessary steps for diagnosis. We studied gastroenterologists’ evaluations of patients with chronic, unexplained, moderate-to-severe gastrointestinal symptoms that were unresponsive to over-the-counter medications.

      Methods

      We performed a cross-sectional online survey of 202 board-certified gastroenterologists at office-based practices, community hospitals, or academic institutions. Respondents had been in active clinical practice for 3 to 35 years post-residency training, spent most of their time on direct patient care, managed ≥1 patient with irritable bowel syndrome and/or functional dyspepsia, and performed ≥1 endoscopy per month. Responses were analyzed to identify barriers to EoG/EoD diagnosis and management.

      Results

      Respondents managed a mean of 1880 patients per year; the most common diagnoses were functional dyspepsia (36%) and gastroesophageal reflux disease (19%). Mean proportions of patients who underwent upper endoscopy ranged from 42% to 84%. Biopsies were collected from >90% of patients with visible endoscopic mucosal abnormalities versus 42% to 72% of patients with normal-appearing mucosae. Approximately 20% of respondents collected only 1-2 biopsies from each site of the gastrointestinal tract. Only 30% routinely requested pathologists to count eosinophils, and nearly 40% had no histologic threshold for EoG/EoD diagnosis.

      Conclusion

      Gastroenterologists vary in their evaluation of patients with chronic, unexplained moderate-to-severe gastrointestinal symptoms. Limited gastric and duodenal biopsy collection, particularly from normal-appearing mucosae, and failure to request tissue eosinophil counts might contribute to underdiagnosis of EoG/EoD. Availability and awareness of EoG/EoD diagnostic guidelines should improve detection in clinical practice.

      Keywords

      Article info

      Publication history

      Accepted: November 16, 2022
      Received in revised form: November 15, 2022
      Received: August 31, 2022

      Publication stage

      In Press Accepted Manuscript

      Footnotes

      Author Contributions: MC and LTG were involved in conceptualizing the project. JT and LTG oversaw project administration. All authors were involved in the formal analysis. JT wrote the first draft, and all authors reviewed, edited, and approved the final draft for submission.

      Conflict of interest: These authors disclose the following: MC received consultant fees from Regeneron, Allakos, Adare/Ellodi, Shire/Takeda, AstraZeneca, Sanofi, Bristol Myers Squibb, and Phathom and research funding from Regeneron, Allakos, Shire/Takeda, AstraZeneca, Adare/Ellodi, and Danone. JT is a former employee of Allakos who was employed by Allakos at the time this study was conducted, the data were analyzed, and the manuscript was drafted and reviewed. LTG is an employee of Allakos and owns stocks and stock options.

      Funding: The study was funded by Allakos (the sponsor), San Carlos, CA. The sponsor participated in the data analysis and interpretation, preparation, and review of the manuscript.

      Data Transparency Statement: Data, analytic methods, and study materials will be made available to other researchers via contacting the corresponding author.

      Ethical Statement: The corresponding author, on behalf of all authors, jointly and severally, certifies that their institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.

      Identification

      DOI: https://doi.org/10.1016/j.gastha.2022.11.010

      Copyright

      © 2022 Published by Elsevier, Inc on behalf of the AGA Institute

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