Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-AGA 2020 Guideline Mgmnt of EoE

AGA 2020 Guideline Mgmnt of EoE

Pdf Summary

The document presents the official clinical practice guidelines for managing Eosinophilic Esophagitis (EoE), developed by the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters (JTF). It offers recommendations based on evidence from numerous trials focusing on short-term treatment modalities, both pediatric and adult. The guidelines emphasize treatment using proton pump inhibitors (PPIs) and topical glucocorticosteroids. PPI treatment is suggested for patients with esophageal eosinophilia, although evidence quality is considered very low; around 42% of studies show a histologic response. Topical glucocorticosteroids are recommended over no treatment due to their moderate quality evidence for effectiveness, with studies showing them failing to induce histologic remission in about a third of patients treated.<br /><br />The document also explores dietary management strategies. Elemental and empiric food elimination diets are both suggested over no treatment, albeit with conditional recommendations due to moderate and low-quality evidence, respectively. There are considerations for patient preferences due to the adherence challenges posed by these diets. Allergy testing-based elimination diets are also discussed, but due to potential accuracy issues, patients may prefer alternative therapies.<br /><br />Other recommendations include using topical over systemic glucocorticosteroids due to reduced systemic complications and a suggestion to continue maintenance treatment with topical glucocorticosteroids in patients achieving short-term remission, although evidence is very low in quality. The guidelines also suggest esophageal dilation for patients with stricture-associated dysphagia.<br /><br />Regarding emerging therapies, the guidelines recommend the use of biologics such as anti–IL-5, anti–IL-13, and anti-IgE therapies only within clinical trials due to insufficient evidence and possible safety concerns. Lastly, the necessity of uniform endpoints in clinical trials and the development of other therapies and tools for monitoring the disease are highlighted as knowledge gaps.

Keywords

Eosinophilic Esophagitis

clinical practice guidelines

American Gastroenterological Association

proton pump inhibitors

topical glucocorticosteroids

dietary management

elemental diets

esophageal dilation

biologics

clinical trials