EoE ToT Module 4 References-Dellon et al Gastroenterology 2018 Updated international consensus diagnostic criteria for EoE Proceedings of the AGREE conference

Dellon et al Gastroenterology 2018 Updated international consensus diagnostic criteria for EoE Proceedings of the AGREE conference

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This document outlines the updated international consensus diagnostic criteria for eosinophilic esophagitis (EoE) established at the AGREE Conference. Traditionally, EoE diagnosis included a trial of proton pump inhibitors (PPIs), to distinguish EoE from gastroesophageal reflux disease (GERD). However, emerging clinical and research evidence suggests EoE and GERD are not mutually exclusive and share overlapping features.<br /><br />Key findings indicate that PPIs can effectively reduce esophageal eosinophilia due to non-acid-mediated mechanisms, making PPIs a treatment rather than a diagnostic tool for EoE. Consequently, the requirement for a PPI trial in diagnosing EoE has been removed from the updated criteria. <br /><br />For a definitive diagnosis of EoE, the updated criteria include:<br /><br />1. Symptoms of esophageal dysfunction, supported by potential concomitant atopic conditions and endoscopic findings.<br />2. At least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy.<br />3. Evaluation to rule out other disorders causing esophageal eosinophilia.<br /><br />The diagnostic algorithm starts with clinical suspicion based on symptoms like dysphagia, abdominal pain, or food impaction. Endoscopy and biopsy are then used to confirm the presence of at least 15 eos/hpf. Evaluation of other potential causes of esophageal eosinophilia follows, ensuring a comprehensive assessment.<br /><br />The document also recognizes the complexities in distinguishing EoE from GERD and provides guidance for clinical evaluation and follow-up. It mentions that patients with symptoms and eosinophilia may respond to classical EoE treatments like dietary modifications or steroids, even if they initially respond to PPIs.<br /><br />Future research directions include exploring the genetic and molecular distinctions between EoE and GERD-related eosinophilia, establishing phenotypic predictors of PPI response, and investigating long-term outcomes of various treatments.<br /><br />In conclusion, the AGREE Conference's findings signify a paradigm shift in the diagnosis of EoE, positioning PPIs as a treatment and emphasizing a comprehensive assessment for diagnosis, reflecting the updated understanding of the disease.

Keywords

eosinophilic esophagitis

EoE

AGREE Conference

diagnostic criteria

proton pump inhibitors

PPIs

gastroesophageal reflux disease

GERD

esophageal eosinophilia

endoscopy