EoE Module 7 References-Rank et al Gastroenterology 2020 Technical review on the management of EoE A report from AGI JTF Allergy Immunology Practice Parameters

Rank et al Gastroenterology 2020 Technical review on the management of EoE A report from AGI JTF Allergy Immunology Practice Parameters

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The management of eosinophilic esophagitis (EoE), a chronic inflammatory condition of the esophagus, has been addressed in a report by the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters. Through a technical review using the GRADE framework, 18 management questions were examined. <br /><br />Topical glucocorticosteroids have moderate certainty in reducing eosinophil counts over 4-12 weeks, though their efficacy as maintenance therapy has very low certainty. Dietary interventions show moderate certainty with elemental diets, but lower certainty with empiric elimination diets. Proton pump inhibitors' (PPIs) role is unclear despite being a common treatment; they may help in symptom management but not necessarily in reducing eosinophil counts.<br /><br />Esophageal dilation is safe for mechanical obstruction relief in EoE, but it doesn't reduce eosinophil levels. Novel biologic therapies like anti-interleukin-5, anti-IL-13, and anti-IgE have not shown clear effectiveness. Other treatments, including systemic glucocorticosteroids, montelukast, cromolyn, and anti-TNF therapies, lack strong evidence for efficacy. <br /><br />The importance of assessing histological remission through endoscopy post-treatment change is highlighted due to the progressive nature of EoE and potential symptom-disease activity discordance. Management should weigh the chronic nature of the disease, potential nutritional impacts of diets, and patient preferences. Current research should aim to refine treatment comparisons to provide clearer guidance. Despite multiple management strategies, further studies with consistent methodologies are needed to better understand and refine EoE management.

Keywords

eosinophilic esophagitis

AGA report

GRADE framework

topical glucocorticosteroids

dietary interventions

proton pump inhibitors

esophageal dilation

biologic therapies

histological remission

treatment comparisons