EoE Module 10 References-Rank et al Gastroenterology 2020 Technical review on the mgmt of EoE A report from the AGA Institute and Joint Task Force

Rank et al Gastroenterology 2020 Technical review on the mgmt of EoE A report from the AGA Institute and Joint Task Force

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This technical review on the management of Eosinophilic Esophagitis (EoE) highlights recent developments and evaluates various treatment strategies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. EoE is a chronic inflammatory condition of the esophagus, increasingly diagnosed in both adults and children, and often associated with other atopic disorders like asthma and eczema.<br /><br />Recommendations based on moderate-certainty evidence suggest that topical glucocorticosteroids effectively reduce esophageal eosinophil counts over a short-term treatment period. The certainty of evidence for long-term maintenance with these steroids is very low. Elemental diets also show moderate-certainty effectiveness in short-term eosinophil reduction, while alternative strategies like empiric food elimination diets and allergy-based dietary eliminations show lower certainty of evidence. The role of proton pump inhibitors (PPIs) remains debated, with evidence indicating very low certainty about their effect on esophageal eosinophilia specifically for EoE, although they are being increasingly considered as a treatment option.<br /><br />Esophageal dilation, though safe, does not reduce eosinophil counts, but offers symptomatic relief for dysphagia. Several other medical treatments are explored, including anti-interleukin therapies, montelukast, and cromolyn, with low to very low certainty in their effectiveness for EoE management, often not excluding or confirming benefits.<br /><br />Topical glucocorticosteroids, elimination diets, and periodic endoscopic evaluations are recommended to manage EoE's chronic nature and potential progression from inflammatory to fibrostenotic disease. Future research should focus on robust comparative studies, combination therapies, and long-term management strategies, particularly focusing on symptom assessment, quality of life, and treatment efficacy. The review consolidates current evidence to guide clinicians in managing EoE, acknowledging a need for more consistent data and evaluation methods to enhance treatment outcomes and patient quality of life.

Keywords

Eosinophilic Esophagitis

EoE management

treatment strategies

GRADE framework

topical glucocorticosteroids

elemental diets

proton pump inhibitors

esophageal dilation

elimination diets

anti-interleukin therapies