EoE Guidelines-British Society of GI and Pediatric GI EoE management adults & pediatrics 2022

British Society of GI and Pediatric GI EoE management adults & pediatrics 2022

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The article presents joint consensus guidelines from the British Society of Gastroenterology (BSG) and the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition (BSPGHAN) on diagnosing and managing eosinophilic oesophagitis (EoE). This chronic inflammatory condition is marked by symptoms like dysphagia (difficulty swallowing) and food impaction in adults, and feeding problems, abdominal pain, or vomiting in children. Diagnostic criteria include an eosinophil count of at least 15 per high power field (or 0.3 mm²) within oesophageal histology, absent other causes of oesophageal eosinophilia.<br /><br />The guidelines emphasize a rounded approach encompassing clinical, endoscopic, and histological assessments. It recommends biopsy during endoscopies for adults showing dysphagia or food bolus obstruction symptoms and children with upper gastrointestinal symptoms or refractory gastro-oesophageal reflux disease (GORD) despite proton pump inhibitor (PPI) treatment. It highlights the importance of taking multiple biopsies across different anatomical oesophageal sites to improve diagnostic accuracy due to the patchy distribution of eosinophils.<br /><br />Management recommendations for EoE cover both pharmacological and dietary interventions. PPI therapy is effective for inducing histological and clinical remission and should be taken for 8-12 weeks before evaluating response; however, PPIs should be halted three weeks prior to endoscopy if an EoE diagnosis is suspected. Topical steroids also show high efficacy for remission induction, but maintenance treatment is required due to high relapse rates. Candidates for dietary interventions, particularly children, should ideally consult experienced dietitians due to the potential for nutritional deficiencies. Practical dietary strategies like the step-up elimination diet (e.g., two-food, progressing to six-food elimination if required) are recommended to boost compliance and minimise the number of endoscopies.<br /><br />The guidelines also cover complications that might arise from EoE, such as oesophageal strictures, for which dilatation combined with anti-inflammatory treatments is suggested. For severe cases like spontaneous perforation, a multidisciplinary approach involving gastroenterologists, surgeons, and radiologists is advised. <br /><br />Future research is urged to elaborate on the causes of EoE, improve diagnostic methodologies, quantify symptom severity accurately, and enhance patient education and shared decision-making. Additionally, comparing the efficacy and cost-effectiveness of different treatment modalities, including novel biologics, is highlighted as a priority.

Keywords

eosinophilic oesophagitis

BSG

BSPGHAN

dysphagia

food impaction

PPI therapy

topical steroids

dietary interventions

oesophageal strictures

diagnostic criteria