EoE Guidelines-Dellon et al Am J Gastroenterol 2025 ACG Clinical Guideline Diagnosis and management of eosinophilic esophagitis

Dellon et al Am J Gastroenterol 2025 ACG Clinical Guideline Diagnosis and management of eosinophilic esophagitis

Pdf Summary

The ACG Clinical Guideline provides an updated framework for diagnosing and managing Eosinophilic Esophagitis (EoE), a chronic immune-mediated esophageal disease. The guideline leverages the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology, providing recommendations across treatment, monitoring, and pediatric-specific considerations for EoE.<br /><br />Diagnosis hinges on identifying esophageal dysfunction symptoms and the presence of at least 15 eosinophils per high-power field in esophageal biopsies, with other causes of eosinophilia ruled out. Endoscopic evaluation is emphasized, with recommendations to use scoring systems like the EoE Endoscopic Reference Score (EREFS) and obtain multiple biopsies to ensure accurate diagnosis.<br /><br />For management, treatment options include proton pump inhibitors (PPIs), topical steroids, empirical food elimination, biologics, and esophageal dilation for strictures. The efficacy of topical steroids is supported by multiple trials, whereas PPIs are recommended beyond their antacid role due to additional therapeutic mechanisms. Dupilumab, a biologic, is suggested for EoE patients unresponsive to PPIs. Dietary interventions, like elimination diets, are effective but require significant patient adherence, with a step-up approach recommended starting with fewer food eliminations.<br /><br />Monitoring involves a comprehensive assessment of symptoms, endoscopic findings, and histologic outcomes to ensure effective disease control. The guidelines emphasize the importance of maintenance therapy due to the chronic nature of EoE, as histologic and symptomatic recurrences are common after stopping treatment.<br /><br />The guideline also highlights the role of adjunctive therapies in pediatrics, like feeding therapy, to address food aversions and ensure proper growth. The guidelines serve as a comprehensive resource to tailor EoE management strategies based on evolving evidence while acknowledging current research gaps needing future investigation.

Keywords

Eosinophilic Esophagitis

ACG Clinical Guideline

diagnosis

management

endoscopic evaluation

treatment options

proton pump inhibitors

topical steroids

dietary interventions

pediatric considerations