EoE Module 10 References-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 American College of Gastroenterology updated its clinical guidelines for diagnosing and managing Eosinophilic Esophagitis (EoE), reflecting significant advancements over the past decade. EoE is identified by symptoms of esophageal dysfunction and the presence of eosinophils, immune cells, in the esophagus. The document outlines recommendations for diagnosis and treatment, including both established and new methods. <br /><br />Diagnosis involves identifying esophageal dysfunction symptoms and confirming at least 15 eosinophils per high-power field in biopsy samples. Endoscopic scoring systems and the collection of multiple biopsies from different esophageal locations are advised to support diagnosis. <br /><br />For treatment, several strategies are recommended: Proton pump inhibitors (PPIs) are suggested despite past use as a diagnostic tool; swallowed topical steroids are recommended as a central treatment, given their moderate-quality evidence of effectiveness. Dietary approaches, including various levels of food elimination diets, are also viable and should be customized to the patient's needs and preferences. <br /><br />The guidelines also cover newer treatments, such as biologic therapies like dupilumab, particularly for cases not responding to PPIs. These treatments offer promising symptom and histologic outcomes, though they present higher costs and specific application criteria. <br /><br />Additionally, maintenance therapy is crucial for preventing recurrence and complications, advocating for the continuation of effective treatments. Monitoring involves both symptoms and objective measures using endoscopic and histological assessments. Emerging non-invasive diagnostic tools could further improve ongoing care.<br /><br />EoE treatment and diagnostics navigate a landscape of evolving therapies and evidence, with a strong emphasis on personalized, patient-centered care. The guidelines highlight current best practices and advocate for continued research to fill knowledge gaps, particularly in non-invasive diagnosis, long-term management strategies, and individual treatment response prediction.

Keywords

Eosinophilic Esophagitis

clinical guidelines

esophageal dysfunction

eosinophils

diagnosis

treatment

proton pump inhibitors

swallowed topical steroids

biologic therapies

personalized care