EoE Module 10 References-Pfefferlé et al Allergy 2024 An algorithm for the diagnosis and treatment of eosinophilic esophagitis in adults 2024

Pfefferlé et al Allergy 2024 An algorithm for the diagnosis and treatment of eosinophilic esophagitis in adults 2024

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The article discusses an updated algorithm for diagnosing and treating eosinophilic esophagitis (EoE) in adults in 2024, addressing the need for rapid diagnosis and effective treatment to reduce symptoms and prevent complications. EoE is a chronic inflammatory disease of the esophagus characterized by Th2-mediated responses. Diagnosis involves suspecting EoE in patients with solid-food dysphagia, performing an esophagogastroduodenoscopy (EGD), and confirming with at least 15 eosinophils per high-power field in biopsies. The disease's patchy nature necessitates multiple biopsies.<br /><br />Variants of EoE, such as EoE-like esophagitis or lymphocytic esophagitis, should be considered when eosinophilic infiltration is absent or low. Treatment goals include achieving clinical and histological remission and preventing complications. First-line treatments for EoE include proton-pump inhibitors (PPIs), topical corticosteroids (TCS), and empirical elimination diets. Medication choice is often at the physician's discretion, although some countries mandate a PPI trial before TCS due to insurance considerations.<br /><br />Long-term management involves regular monitoring every 1-2 years using EGD, as discrepancies between clinical and histological activities are common. Family adherence to maintenance treatment is crucial due to the chronic nature of EoE. Alternative treatments, like the IL4/13 antibody Dupilumab, are recommended for treatment-resistant patients or those with contraindications to standard therapies. Endoscopic dilation may benefit patients with fibrostenotic phenotypes.<br /><br />The article was funded by multiple grants and acknowledges no conflicts of interest from one author, while disclosing consulting activities by another. The study emphasizes the importance of indefinite maintenance treatment and discourages cessation, underlining the necessity of thorough and consistent follow-up for effective long-term management.

Keywords

eosinophilic esophagitis

EoE diagnosis

EoE treatment

Th2-mediated response

proton-pump inhibitors

topical corticosteroids

Dupilumab

esophagogastroduodenoscopy

biopsies

chronic inflammatory disease