Interdisciplinary care, adherence challenges common in eosinophilic esophagitis treatment
Key takeaways:
- All the allergists and immunologists who responded said they collaborate with gastroenterologists.
- 43% of clinicians and 64% of patients and caregivers called diet management a significant challenge.
SAN DIEGO — Treatment for eosinophilic esophagitis often involves collaboration between specialists, but patients face challenges in adherence, according to a pair of posters presented here.
Models for multidisciplinary care and identifying these barriers may improve outcomes, Hannah Jaffee, MS, director of research, Asthma and Allergy Foundation of America (AFAA), said at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
“Since it was first characterized in 1993, prevalence of EoE has steadily increased in the United States,” Jaffee told Healio. “Research suggests EoE significantly impacts patients and their families physically, socially, mentally and financially.”
But less has been known about the various factors that contribute to these impacts across the patient journey, from pre-diagnosis to long-term management, she continued.
With that, the AAFA and the American Partnership for Eosinophilic Disorders (APFED) collaborated on a survey to better understand the patient journey and current state of EoE care in the United States, Jaffee said.
“We also wanted to identify unmet needs for EoE patients, family members and clinicians to outline opportunities to improve EoE care in the United States,” Jaffee said.
The 13-minute, self-reported survey polled 160 adults with EoE or caregivers of a patient with EoE (54% adult patients; 46% caregivers; 89% white; 85% female) in addition to 110 clinicians who treat EoE.
Clinicians included gastroenterologists (35%), primary care providers (24%), allergists and immunologists (19%), otolaryngologists (10%), nurses or physician assistants (6%), ED physicians (4%) and other (2%).
Approximately two-thirds of patients (65%) saw more than one type of health care provider for their EoE, including gastroenterologists (81%), allergists and immunologists (62%), primary care providers (38%), dietitians (15%) and psychologists (4%).
The health care providers reported high levels of collaboration between specialists. For example, all the allergists and immunologists said that they collaborate with gastroenterologists when they treat patients with EoE.
Also, 82% of gastroenterologists and 69% of primary care physicians said they collaborate with allergists and immunologists in EoE care, and 62% of gastroenterologists, 62% of allergists and immunologists and 69% of primary care physicians said they collaborate with dietitians and nutritionists.
“Multidisciplinary care in EoE can help reduce redundancies and improve patient care. Different specialists can help manage different aspects of EoE, and our study found that people with EoE often see more than one type of health care provider for their EoE care,” Jaffee said.
“Having multidisciplinary care models can help establish protocols for different specialists to work together to provide coordinated patient-centered medical care,” she continued.
As for treatment, 57% of patients and caregivers reported using elimination diets, 34% reported using proton pump inhibitors, 25% reported using swallowed glucocorticoids and 9% reported using biologics.
Treatments reported by clinicians included proton pump inhibitors, with 47% reporting that they always prescribe them, and elimination diets, with 18% reporting that they always prescribe them.
The most common challenge in EoE management was patient adherence to treatment, reported 76% of the clinicians. Adherence was better in pharmacological treatments, as 87% of clinicians said they saw more than 50% adherence, compared with diet therapy, with 40% of clinicians reporting more than 50% adherence.
Specifically, 43% of clinicians and 64% of patients and caregivers called diet management a significant challenge.
Based on these findings, the researchers called multidisciplinary care common in EoE treatment, with reduced redundancy and improved outcomes possible with established models for multidisciplinary care. Further, they said, identifying barriers to treatment adherence and developing strategies for overcoming them would improve outcomes as well.
“Our research showed that only 15% of EoE patients report seeing a dietitian or nutritionist who can provide tailored guidance on dietary therapy and nutrition. Additionally, among the clinicians we surveyed, less than 20% said they collaborate with psychologists for EoE care,” Jaffee said.
“Given the intricacies of dietary treatment, and the psychosocial toll of EoE, incorporating these professionals into multidisciplinary care models can help further ensure efficient and comprehensive EoE care,” she added.
Jaffee also noted that dietary restrictions can be burdensome for patients with EoE and their families, requiring planning and impacting dining out, holidays, social gatherings and travel, among other activities. Plus, specialty foods and formula can be cost barriers.
“Most EoE patients and caregivers surveyed in our study cited diet management as the biggest challenge with EoE management,” Jaffee said. “The cost of food management, impacts on social life, and trigger management were all listed as challenges in open-ended responses as well.”
The clinicians who responded reported better adherence to pharmacological treatments, she further explained, but proton pump inhibitors, topical corticosteroids and other treatments are not indicated specifically for EoE treatment, limiting access and insurance coverage.
“Additionally, insurance requirements may delay or prevent the use of biologics for EoE,” she said.
Noting how respondents listed diet management as a major challenge, Jaffee said increased awareness of available resources to help implement and manage dietary therapy among health care providers is important.
“This can help providers expand practical strategy resources to help improve adherence,” she said. “For better adherence to pharmacological treatments, clinicians can use shared decision-making tools that consider patients' lifestyles and preferences to determine an appropriate course of therapy that patients can reasonably access, afford and adhere to.”