EoE Guidelines-Hirano I, Chan ES, Rank MA, et al. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Gastroenterology .

Hirano I, Chan ES, Rank MA, et al. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Gastroenterology .

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The clinical practice guidelines co-developed by the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters provide comprehensive, evidence-based recommendations for managing Eosinophilic Esophagitis (EoE). EoE is a chronic immune/antigen-mediated disease marked by eosinophilic infiltration in the esophagus, affecting both children and adults, and often associated with atopic conditions like asthma and allergic rhinitis. The guidelines emphasize the use of proton pump inhibitors (PPIs) as a conditional treatment due to their modest histologic response compared to placebo, although they now hold a primary therapeutic stance post exclusion from diagnostic criteria. Topical glucocorticosteroids receive a strong recommendation due to moderate evidence of efficacy, whereas systemic steroids are reserved for severe cases due to side effects. <br /><br />For dietary interventions, an elemental diet is recommended conditionally due to adherence challenges, while a 6-food elimination diet is suggested for its efficacy despite being demanding. The role of allergy testing in dietary management is considered with caution given current limitations in accuracy. Maintenance therapy with topical steroids is conditionally recommended to prevent relapse, though evidence is limited. Endoscopic dilation is suggested for symptomatic relief in patients with strictures but doesn't treat underlying inflammation. <br /><br />Emerging biologic therapies, such as anti–IL-5 and anti–IL-13, are currently advised only within clinical trials until more conclusive data are available. Anti-IgE therapy is not recommended due to minimal efficacy evidence. The guidelines highlight key knowledge gaps, specifically in long-term management, and call for more consistent outcome measures in research. The collaborative development reflects the interdisciplinary approach needed to manage EoE effectively.

Keywords

Eosinophilic Esophagitis

AGA guidelines

allergy-immunology

proton pump inhibitors

topical glucocorticosteroids

elemental diet

6-food elimination diet

endoscopic dilation

biologic therapies

interdisciplinary management