EoE Module 1 References-Dellon et al Am J Gastroenterol 2013 ACG clinical guidelines Evidence based approach to the diagnosis and mgmt of EoE

Dellon et al Am J Gastroenterol 2013 ACG clinical guidelines Evidence based approach to the diagnosis and mgmt of EoE

Pdf Summary

Eosinophilic esophagitis (EoE) is a rapidly evolving gastrointestinal disease characterized by esophageal dysfunction, eosinophil-predominant inflammation, and an allergic pathogenesis. Distinguishing EoE from gastroesophageal reflux disease (GERD) and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is critical for diagnosis and treatment. EoE diagnosis requires clinical evaluation, esophageal biopsies showing ≥15 eosinophils per high-power field, and exclusion of other causes after a PPI trial.<br /><br />Topical corticosteroids, such as fluticasone or budesonide (swallowed, not inhaled), are the first-line pharmacologic treatment. Dietary interventions like elimination diets have shown effectiveness, particularly in children, but entail significant commitments due to the need for careful monitoring and reintroduction of foods. Esophageal dilation is reserved for patients with strictures or narrow-caliber esophagus that persist despite medical or dietary treatment.<br /><br />The GRADE system assessed the recommendations' strength and evidence quality, acknowledging that most recommendations are conditional due to limited data, emphasizing ongoing research and potential for evolving guidelines. Maintenance strategies, including sustained topical steroid use or dietary management, are suggested due to EoE's chronic nature and high recurrence rate post-treatment. Collaborative management involving gastroenterologists, allergists, and possibly dieticians is recommended to optimize patient care and treatment outcomes.<br /><br />In summary, EoE management involves a multifaceted approach focusing on accurate diagnosis, effective initial treatment with topical steroids or dietary changes, cautious use of esophageal dilation, patient education on chronic disease course, and considering maintenance therapies to prevent symptom recurrence and manage complications.

Keywords

Eosinophilic esophagitis

EoE

esophageal dysfunction

eosinophil inflammation

allergic pathogenesis

topical corticosteroids

elimination diets

esophageal dilation

chronic disease

maintenance therapies