EoE Module 8 References-Hirano et al Gastroenterology 20120 AGA Intitute and Joint Task Force__

Hirano et al Gastroenterology 20120 AGA Intitute and Joint Task Force___clinical guidelines for the mgmt of EoE

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The clinical practice guidelines for managing eosinophilic esophagitis (EoE) have been jointly developed by the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters. These guidelines are aimed at offering evidence-based recommendations for treating EoE in both pediatric and adult patients.<br /><br />EoE is characterized by chronic, immune-mediated esophageal inflammation linked to food antigen-driven Th2 inflammation. The condition often coincides with other atopic diseases like asthma and allergic rhinitis. Over recent decades, the recognition of EoE has increased, leading to comprehensive studies and trials on effective treatment options.<br /><br />The guidelines recommend proton pump inhibitors (PPIs) and topical glucocorticosteroids as primary treatments. While PPIs provide a conditional recommendation due to very low-quality evidence, topical glucocorticosteroids have strong support for efficacy and safety, as indicated by moderate-quality evidence. Systemic glucocorticosteroids are suggested only when topical treatments fail, due to their increased side effects.<br /><br />Dietary interventions, including elemental diets and empiric six-food elimination diets, are recommended with acknowledgment of their challenges, such as issues with adherence and the process of dietary reintroduction. Allergy-based elimination diets also receive conditional recommendations due to limited accuracy of current allergy testing methods.<br /><br />The guidelines further suggest endoscopic dilation for strictures caused by EoE in adult patients. However, they emphasize that esophageal dilations address urgent symptom relief rather than the underlying inflammation.<br /><br />Emerging therapies, such as anti-IL-5 and anti-IL-13 treatments, are currently advised only within the scope of clinical trials due to insufficient evidence on their long-term impact.<br /><br />Additionally, the guidelines highlight the need for uniform outcomes in clinical trials and urge further study into EoE’s natural progression and long-term management strategies.<br /><br />In sum, the recommendations presented offer both immediate treatment options for EoE and acknowledge areas where further research is necessary to optimize patient outcomes.

Keywords

eosinophilic esophagitis

clinical practice guidelines

American Gastroenterological Association

proton pump inhibitors

topical glucocorticosteroids

dietary interventions

endoscopic dilation

anti-IL-5 treatments

anti-IL-13 treatments

allergy testing