Girish Hiremath, MD, MPH: Pediatric Compliance to EoE Therapies


An expert discusses a study assessing the effects of low compliance to eosinophilic esophagitis therapies among pediatric patients.

Children with eosinophilic esophagitis (EoE) may face barriers or challenges when it comes to adhering to or properly using therapeutic agents like proton pump inhibitors (PPI) and topical corticosteroids (TCS).

Improper use of these pharmacologic agents can potentially lead to persistence of eosinophilic inflammation or esophageal remodeling and food impaction.

A new study presented at the annual American College of Gastroenterology (ACG) 2020 conference assessed the relationship between PPI/TCS compliance and EoE status and the peak eosinophil count (PEC) in pediatric patients. The study also sought to determine whether there were any patient factors that were associated with 100% compliance.

The team, led by Girish Hiremath, of Vanderbilt University Medical Center, used self-reported assessments to measure compliance (rated 0% - 100%) among 37 children with EoE prior to their esophagogastroduodenoscopy (EGD).

The investigators also gathered demographic and clinical information, as well as PEC and EoE activity status. Active EoE was based on a PEC threshold of 15.

Thus, they found that the median self-reported compliance was 100% (range, 50-100%).

Furthermore, PEC was found to negatively correlate with increasing medication compliance (Spearmen’s rho = -0.33; P = .04).

Additionally, the median PEC was slightly lower in children with 100% compliance (3; range, 0-35) when compared with those with <100% compliance (40; range, 4-73).

And finally, Hiremath and colleagues reported that there was a significantly lower proportion of children with active EoE in the 100% compliance group (38%) than the lower compliance group (64%).

There was no noted association between demographic / clinical factors and 100% compliance to PPI / TS.

The team recognized that higher powered studies that use more objective methods to determine medication adherence are warranted.

Hiremath spoke with HCPLive® about these potential challenges that may prevent pediatric patients from strictly adhering to their medication, such an inability to swallow pills or fasting requirements.

He emphasized the importance of synergy between guardians and clinicians in helping to overcome these challenges.

“Especially in the world of EoE, there’s a lot of teamwork where the family and physicians work together,” he said. “So, I think it’ll be important for the physicians to have an ear for what kind of barriers the family or the patient faces and how [they] can help them overcome those barriers.”

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