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217 Guideline adherence 10 The self-reported frequency with which items from the medical history and physical examination were put into practice was scored on a 5-point Likert scale (never-rarely- sometimes-often-always). For the interpretation of the results, we considered ‘often’ or ‘always’ on the 5-point Likert scale as ‘frequent’ performance of an item. For each question, responders had the option to an open answer in case they considered the multiple choice answers to be insufficient. Statistical analysis Analyses were conducted using IBMSPSS Statistics v23.0 (IBM, Amsterdam, the Netherlands). For questions where the responder had to choose one of the provided answers (questions 1-7, 9, 11, 13, 16-19, see Supplemental Digital Content, http://links.lww.com/MPG/B148) , only cases with available data were analyzed; cases with missing data were excluded from these analyses. For questions with multiple possible answers, only affirmative answers are reported as proportion of the total group (questions 8, 10, 12, 14, 15, see Supplemental Digital Content, http://links.lww.com/MPG/B148) . Confidence intervals were calculated according to the Clopper-Pearson method. For the comparison of dichotomous categorical variables between two groups, Fisher’s exact tests were performed. P -values of < .05 were considered to be statistically significant. This study was approved by the Medical Ethics Committee of the Academic Medical Center. RESULTS Participants In total, 418 questionnaires were returned. Ninety questionnaires were excluded (Figure 1). Responder characteristics and familiarity with the guideline Responder characteristics are shown in Table 1. Of the 328 included questionnaires, 67% were filled out by physicians from the U.S. and 34% by physicians from the Netherlands. The majority of responders (92%) were attending physicians and 58% of them worked in the field of general pediatrics. Significantly more responders from the U.S. (50%) worked in pediatric gastroenterology compared to responders from the Netherlands (26%, P < .001). Just over half of U.S. responders (53%) worked in primary care or private practice whereas all responders from the Netherlands worked in a hospital setting. A total of 31% [CI 26- 36%] reported that they were not familiar with the 2014 ESPGHAN/NASPGHAN guideline, unfamiliarity with the guideline was more common in responders from the U.S. compared to the Netherlands (Table 2). Moreover, unfamiliarity with the guideline was significantly more common in pediatricians compared to pediatric gastroenterologists and in physicians