Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-ACG 2013 Guideline Dx and Management of EoE

ACG 2013 Guideline Dx and Management of EoE

Pdf Summary

The guidelines on eosinophilic esophagitis (EoE), presented by the American College of Gastroenterology, explore the challenges and advancements in the diagnosis and treatment of this increasingly recognized condition. EoE is defined as a chronic, immune-mediated esophageal disease characterized by symptoms related to esophageal dysfunction and histologic eosinophil-predominant inflammation. It is diagnosed by considering clinical and pathologic evidence without interpreting either in isolation.<br /><br />Key recommendations include the necessity of biopsies for diagnosis and for making distinctions between EoE, gastroesophageal reflux disease (GERD), and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE). The guideline emphasizes the importance of a PPI trial to differentiate between EoE and PPI-REE before formal EoE diagnosis.<br /><br />For treatment, first-line pharmacologic therapies include swallowed topical steroids such as fluticasone and budesonide, which are effective in reducing esophageal eosinophilia and improving symptoms. Dietary modifications, like elemental or elimination diets, are also considered crucial, with the approach tailored to individual patient needs. Endoscopic dilation is advised for addressing esophageal strictures. However, the guideline warns of risks such as post-dilation chest pain and underscores patient awareness.<br /><br />Although EoE is chronic with high symptom recurrence post-treatment cessation, long-term maintenance therapy—whether through ongoing dietary management or continued pharmacologic intervention—is recommended, particularly for patients with severe symptoms or fibrotic complications. Collaboration with allergists and dietitians is encouraged to enhance patient care and management.<br /><br />Highlighting the dynamic nature and evolving understanding of EoE, the guidelines acknowledge the need for continued research to refine diagnostic criteria, treatment modalities, and long-term maintenance strategies.

Keywords

Eosinophilic Esophagitis

American College of Gastroenterology

Diagnosis

Treatment

Biopsies

PPI trial

Topical steroids

Dietary modifications

Endoscopic dilation

Long-term maintenance