EoE ToT Module 3 References-Dellon et al Am J Gastroenterol 2013 ACG clinical guidelines Evidence based approach to the diagnosis and management of EoE

Dellon et al Am J Gastroenterol 2013 ACG clinical guidelines Evidence based approach to the diagnosis and management of EoE

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The American Journal of Gastroenterology published a set of clinical guidelines for the diagnosis and management of Esophageal Eosinophilia (EoE) and Eosinophilic Esophagitis (EoE). EoE is recognized for its increasing prevalence and is marked by symptoms of esophageal dysfunction coupled with eosinophil-predominant inflammation, usually diagnosed when >15 eosinophils per high-power field are found on esophageal biopsy. The disorder can overlap symptomatically with gastroesophageal reflux disease (GERD) and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE).<br /><br />The guidelines emphasize the following:<br />1. Diagnosis requires consideration of both clinical symptoms and pathological findings, with necessary biopsies from both proximal and distal esophagus. Secondary causes should be ruled out, and PPI-REE should be excluded.<br />2. Treatment includes topical steroids like fluticasone or budesonide, often effective for both children and adults. Systemic steroids are reserved for cases unresponsive to topical treatments or needing rapid symptom control.<br />3. Dietary management can involve targeted or empiric elimination diets, often supported by allergy testing. Elemental diets are the most effective but pose practical challenges.<br />4. Esophageal dilation is recommended for patients with strictures unresponsive to medical or dietary therapy, employing a conservative approach due to risks like chest pain and perforation.<br />5. Maintenance therapy, due to the chronic nature of EoE, is recommended especially for those with severe symptoms, strictures, or rapid relapse. Both topical steroids and dietary management are viable options.<br /><br />The guidelines incorporate evidence-based recommendations, reflecting the data available to date and highlighting areas needing further research such as long-term outcomes and the potential for non-invasive diagnostic tools. The management plan should be tailored to individual patients' needs, balancing efficacy, safety, and quality of life considerations.

Keywords

Esophageal Eosinophilia

Eosinophilic Esophagitis

clinical guidelines

esophageal biopsy

topical steroids

dietary management

esophageal dilation

maintenance therapy

proton-pump inhibitors

GERD