{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:43:43Z","timestamp":1792669423365,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Eosinophilic esophagitis (EoE) patients deemed treatment\u2010refractory are frequently referred to tertiary centres. We aimed to characterize expert perspectives on patients referred for refractory EoE, including its causes, prevalence, and evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted an anonymous and blinded cross\u2010sectional survey of international EoE experts (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952) assessing provider characteristics, referral patterns, perceived causes of treatment failure, diagnostic approaches, and prior therapies. Descriptive statistics and subgroup analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Respondents were predominantly gastroenterologists (77%) and practiced in academic settings (87%) with high EoE volume. Experts estimated that true refractoriness to medical and diet therapy was 15% [IQR 10\u201325], median 31% [20\u201350], respectively. Patients referred for perceived refractory EoE had been treated with PPIs (80%), topical steroids (55%), and elimination diets (45%); dupilumab (10%) was infrequently trialled. Half of the patients referred had been on combination therapy. After referral, experts focused on assessing medication adherence (98%), dosing (92%), and administration technique (90%), with most repeating endoscopy (85%) and performing oesophageal dilation (42%). The causes of perceived refractory disease were subtherapeutic dosing (34%), incorrect medication administration (30.5%), inappropriate medication choice (26.5%), and dietary non\u2010adherence (26%). Functional and behavioural contributors including co\u2010existing oesophageal hypersensitivity (20%), ARFID (9%), and rumination syndrome (5%) were also reported. Experience in treating EoE patients assessed by less than or greater than 10\u2009years did not affect most results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among international experts, most referred EoE patients labelled as refractory had received suboptimal medical and dilation therapy. This highlights opportunities to optimize care along guideline recommendations prior to referral.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70951","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:44:20Z","timestamp":1787888660000},"page":"1414-1420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment Patterns in Patients With Eosinophilic Oesophagitis Referred for Expert Consultation"],"prefix":"10.1111","volume":"64","author":[{"given":"Sydney F.","family":"Pomenti","sequence":"first","affiliation":[{"name":"Division of Digestive Diseases Columbia University  New York N.Y USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7872-0935","authenticated-orcid":false,"given":"Elina","family":"Stoffel","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases Columbia University  New 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Gastroenterology and Hepatology University of North Carolina Chapel Hill School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2307-2317","authenticated-orcid":false,"given":"David A.","family":"Katzka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Medical University of South Carolina  Charleston S.C 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