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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Adherence to Celiac Disease and Eosinophilic Esophagitis Biopsy Guidelines Is Poor in Children
Thomas Wallach1, Robert M Genta, Benjamin Lebwohl
1*Department of Pediatrics, Division of Pediatric Gastroenterology, University of California San Francisco, San Francisco, CA †University of Texas-Southwestern Medical Center, Dallas, TX ‡Miraca Life Sciences Research Institute, Irving, TX §Department of Medicine, Celiac Disease Center ||Division of Pediatric Gastroenterology, Columbia University College of Physicians and Surgeons, New York, NY.
Insights
Adherence to celiac disease (CD) and eosinophilic esophagitis (EoE) diagnostic guidelines is poor in pediatric patients. Improved adherence to these guidelines significantly increases the detection rates of CD and EoE in children.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Clinical Guideline Adherence
Background:
- Celiac disease (CD) and eosinophilic esophagitis (EoE) are frequently underdiagnosed gastrointestinal disorders in children.
- Previous research indicates inconsistent adherence to diagnostic guidelines for CD in adults.
- Understanding adherence in pediatric populations is crucial for improving diagnosis and patient outcomes.
Purpose of the Study:
- To evaluate endoscopist compliance with established diagnostic guidelines for CD and EoE in pediatric patients.
- To determine the association between adherence to biopsy guidelines and the detection rates of CD and EoE in children.
Main Methods:
- Retrospective review of pathology reports from 9171 children (0-18 years) with duodenal biopsies and 8280 children with esophageal biopsies.
- Assessment of adherence to 2006 American Gastroenterological Association guidelines for CD and 2007 EoE consensus recommendations.
- Statistical analysis to determine the impact of guideline adherence on disease detection.
Main Results:
- Only 35% of CD cases and 8% of EoE cases met guideline recommendations for biopsies.
- Disease detection rates for both CD and EoE increased significantly with the number of biopsies taken.
- Poor adherence was noted in patients with histologically normal mucosa.
- Guideline adherence was significantly associated with higher odds of CD (OR 6.3) and EoE (OR 2.4) diagnosis.
Conclusions:
- Adherence to current diagnostic guidelines for CD and EoE in pediatric endoscopy is suboptimal.
- Improved adherence to these guidelines is directly correlated with enhanced detection rates of these gastrointestinal conditions in children.
Objectives:
Celiac disease (CD) and eosinophilic esophagitis (EoE) are underdiagnosed gastrointestinal conditions, which adversely affect children's health. Previous studies have shown that diagnostic guidelines for CD are not consistently followed in adults. The aims of the present study are to assess the frequency with which endoscopists comply with diagnostic guidelines for CD and EoE in children, and to determine whether an association exists between adherence to biopsy guidelines and disease detection in pediatric patients.
Methods:
We reviewed pathology reports from 9171 children (ages 0-18) with at least 1 duodenal biopsy, and 8280 children with at least 1 esophageal biopsy, with specimens submitted to a national pathology laboratory. Frequency of adherence to diagnostic guidelines and recommendations for CD and EoE were determined, and the effect of this upon detection of CD and EoE.
Results:
Overall, 35% of cases were biopsied according to the 2006 American Gastroenterological Association guidelines for CD diagnosis; 8% were biopsied according to the 2007 American Gastroenterological Association EoE consensus recommendations. Detection of CD and EoE increased with the number of biopsies collected (P for trend in each <0.001). Adherence to diagnostic guidelines was particularly poor among those found to have histologically normal mucosa in both cohorts. The likelihood of CD and EoE diagnosis was significantly associated with adherence to diagnostic guidelines (odds ratio for CD 6.3, 95% confidence interval 4.4-8.9; odds ratio for EoE 2.4, 95% confidence interval 1.9-2.9).
Conclusion:
Adherence to established guidelines is poor, and improved guideline adherence is associated with greater disease detection rates for CD and EoE.
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