EoE Module 7 References-Dellon et al Am J Gastroenterol 2013 ACG clinical guidelines Evidenced based approach for diagnosis and mgmt EoE

Dellon et al Am J Gastroenterol 2013 ACG clinical guidelines Evidenced based approach for diagnosis and mgmt EoE

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The 2013 guidelines by the American College of Gastroenterology outline the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE), recognizing these conditions as increasingly prevalent clinical challenges. EoE, an immune-mediated disease, is characterized by symptoms related to esophageal dysfunction and a predominance of eosinophils in esophageal biopsy specimens. Diagnosing EoE involves ruling out other causes of esophageal eosinophilia, such as gastroesophageal reflux disease (GERD) and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE), using a PPI trial to distinguish these from EoE.<br /><br />The guidelines recommend esophageal biopsies for diagnosis and stress the importance of identifying the causes of eosinophilia before starting treatment. First-line treatments for EoE include swallowed topical corticosteroids like fluticasone or budesonide and dietary elimination, tailored to individual needs. The response is measured through improvement in clinical symptoms and reduction in esophageal eosinophilia, accepting that complete symptom resolution may not always be feasible.<br /><br />Esophageal dilation is advised for patients with strictures or significant narrowing of the esophagus that do not respond to medical or dietary therapies. While dilation is effective, it requires careful consideration of risks, including post-procedure chest pain and potential bleeding.<br /><br />EoE is identified as a chronic condition with a high likelihood of recurrence in symptoms if treatment is discontinued. Maintenance therapy, using either continued topical steroids or dietary restrictions, is suggested to minimize symptoms and prevent complications, particularly for patients with severe presentations or rapid relapse after initial treatment.<br /><br />Overall, the guidelines provide a comprehensive assessment strategy and treatment recommendations, emphasizing the need for careful differential diagnosis and tailored management approaches for individuals with EoE to improve patient outcomes and quality of life. Future advancements are expected to refine diagnostic and therapeutic methodologies further.

Keywords

Esophageal Eosinophilia

Eosinophilic Esophagitis

American College of Gastroenterology

Diagnosis

Management

Topical Corticosteroids

Dietary Elimination

Esophageal Dilation

Chronic Condition

Maintenance Therapy