EoE Module 7 References-Hirano et al Gastroenterology 2020 AGA Institute and JTF on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of EoE

Hirano et al Gastroenterology 2020 AGA Institute and JTF on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of EoE

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The document presents official clinical practice guidelines from the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters for managing eosinophilic esophagitis (EoE). Developed through a collaborative process, including public comment and peer review, the guidelines address recommendations for both pediatric and adult patients with EoE, a food antigen-driven Th2 inflammatory disease also linked to aeroallergen sensitivity and other atopic conditions like asthma.<br /><br />Key recommendations focus on various treatments for EoE. The use of proton pump inhibitors (PPIs) is conditionally advised due to modest histologic response rates and mixed efficacy. Topical glucocorticosteroids are strongly recommended based on moderate-quality evidence for inducing histologic remission. Systemic glucocorticosteroids are conditionally discouraged in favor of topical alternatives due to potential side effects. Elemental diets, although effective, have practical challenges like adherence and potential nutritional deficits, leading to a conditional recommendation. Similarly, an empiric six-food elimination diet, while effective, is conditionally proposed due to complexities in dietary management and food reintroduction.<br /><br />Allergy testing-based elimination diets come with a conditional recommendation due to limitations in accuracy. Maintenance therapy, particularly after using topical glucocorticosteroids, is advised based on very low-quality evidence due to EoE's chronic nature and progression risk. Esophageal dilation is conditionally recommended for adults with EoE-related strictures, but it doesn't address underlying inflammation.<br /><br />Novel biological therapies are suggested only within clinical trials due to existing knowledge gaps. The guidelines emphasize the need for uniform endpoints in clinical trials and further research into EoE's natural history, therapeutic effects, and potential new treatments. Overall, personalized management based on individual patient needs and preferences is crucial.

Keywords

eosinophilic esophagitis

clinical practice guidelines

American Gastroenterological Association

food antigen-driven

proton pump inhibitors

topical glucocorticosteroids

elemental diets

six-food elimination diet

esophageal dilation

biological therapies