Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-2022 British Society Guideline on dx and management of EoE

2022 British Society Guideline on dx and management of EoE

Pdf Summary

The guidelines from the British Society of Gastroenterology and the British Society of Paediatric Gastroenterology, Hepatology and Nutrition provide comprehensive recommendations on diagnosing and managing eosinophilic oesophagitis (EoE) in both children and adults. EoE is characterized by eosinophilic inflammation of the esophagus, causing symptoms like dysphagia (difficulty swallowing) and food impaction.<br /><br />The guidelines outline the diagnostic process, emphasizing the necessity of esophageal biopsies, even if the endoscopic appearance is normal, due to the patchy nature of eosinophilic infiltration. At least six biopsies are recommended from various esophageal sites to confirm diagnosis, with eosinophil counts required to be ≥15 per high power field (0.3mm²) for a diagnosis.<br /><br />Management includes dietary changes, pharmacological treatments, or both. Elimination diets, particularly starting with a two-food elimination diet, are emphasized, but they require careful progression and oversight by an experienced dietitian. Pharmacological management with proton pump inhibitors (PPIs) and topical steroids like budesonide or fluticasone is standard, though PPI efficacy varies among individuals.<br /><br />Complications like esophageal strictures may occur, but these can be managed with endoscopic dilation and proactive anti-inflammatory treatment to prevent further stricture formation. The guidelines discourage systemic steroid use due to potential side effects and recommend against using immune-modulating drugs and biologics except under specific circumstances.<br /><br />Continual research is needed to understand EoE better, including its causes, progression, and the effectiveness of new therapies, along with non-invasive diagnostic techniques. The guidelines aim to standardize EoE diagnosis and treatment, improving patient care through clear, evidence-based recommendations developed in consultation with various healthcare professionals and patient advocates.

Keywords

Eosinophilic oesophagitis

British Society of Gastroenterology

Paediatric Gastroenterology

Esophageal biopsies

Dietary management

Proton pump inhibitors

Topical steroids

Esophageal strictures

Endoscopic dilation

Patient care guidelines