EoE Module 10 References-Hirano et al Gastroenterology 2020 AGA institute and joint task force on allergy__

Hirano et al Gastroenterology 2020 AGA institute and joint task force on allergy___mgmt of EoE

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The document presents clinical guidelines from the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters for managing eosinophilic esophagitis (EoE). EoE, a food antigen-driven inflammatory condition diagnosed in the early 1990s, is associated with other atopic conditions like asthma and allergic rhinitis. These guidelines are jointly developed and approved by leading gastroenterology and allergy/immunology bodies.<br /><br />**Recommendations:**<br /><br />1. **Proton Pump Inhibitors (PPI):** Suggested as an initial treatment for patients with esophageal eosinophilia, despite very low-quality evidence of efficacy.<br /><br />2. **Topical Glucocorticosteroids:** Strongly recommended for treating EoE, supported by moderate evidence, showing effectiveness over placebo.<br /><br />3. **Systemic vs. Topical Glucocorticosteroids:** Topical steroids are preferred over oral glucocorticosteroids due to a better safety profile.<br /><br />4. **Elemental Diet:** Conditional recommendation due to challenges in adherence and the moderate quality of evidence supporting its use over no treatment.<br /><br />5. **Empiric Food Elimination Diet:** Suggested over no treatment, conditional on patient adherence capability, supported by low-quality evidence.<br /><br />6. **Allergy-Based Elimination Diets:** Suggested conditionally as evidence is very low; patient preference may lean towards other therapies due to potential dietary challenges and limited accuracy.<br /><br />7. **Maintenance Therapy:** Continuation of topical steroids after achieving remission is conditionally suggested due to very low-quality evidence.<br /><br />8. **Esophageal Dilation:** Conditionally suggested for adult patients with dysphagia from strictures but doesn't address inflammation.<br /><br />9. **Anti–Interleukin (IL)-5, IL-13, and IL-4 therapies:** Recommended only within clinical trials due to insufficient evidence for routine clinical use.<br /><br />10. **Anti-IgE Therapy:** Suggested against due to lack of efficacy evidence and a plausible mechanism in EoE.<br /><br />Further gaps are identified in understanding EoE's natural history, treatment combinations, and long-term management strategies. Uniform study endpoints and prospective long-term studies are urged to better guide EoE treatment. The document highlights the need for more robust and comprehensive clinical data to inform ongoing and future management practices for EoE.

Keywords

eosinophilic esophagitis

AGA guidelines

allergy-immunology

proton pump inhibitors

topical glucocorticosteroids

elemental diet

food elimination diet

esophageal dilation

interleukin therapies

clinical trials