EoE ToT Module 4 References-Dhar et al Gut 2022 BSG and BSPGHAN joint consensus GLS on the diagnosis of EoE in children and adults

Dhar et al Gut 2022 BSG and BSPGHAN joint consensus GLS on the diagnosis of EoE in children and adults

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The British Society of Gastroenterology (BSG) and the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition (BSPGHAN) released guidelines in 2022 on diagnosing and managing eosinophilic esophagitis (EoE) in children and adults. EoE is an increasingly prevalent condition causing dysphagia and significant health impacts. The guidelines offer best practices for evaluation and treatment based on a systematic review and expert consensus.<br /><br />Key recommendations include:<br />1. EoE is identified by symptoms of dysphagia or food impaction in adults, and feeding issues or abdominal pain in children, with eosinophil counts ≥15 per high power field (HPF).<br />2. The prevalence of EoE is rising in both demographic groups, with higher rates in males and white ethnic groups.<br />3. Seasonal symptoms correlate with pollen counts, and a strong familial link suggests a genetic component.<br />4. For adults and children undergoing endoscopy for suspected EoE, biopsies are necessary even if the esophagus appears normal.<br />5. Proton pump inhibitors (PPIs) should be discontinued three weeks before endoscopy to avoid obscuring a diagnosis.<br />6. The guidelines recommend a minimum of six biopsies from different esophageal sites to ensure accurate diagnosis, with eosinophil density expressed per 0.3 mm².<br />7. Therapeutic options include dietary elimination and pharmacological treatment with PPIs or topical steroids. The six-food elimination diet shows high histological remission but lower compliance.<br />8. Long-term management includes maintaining remission with topical steroids, which have fewer side effects compared to systemic steroids.<br /><br />The guidelines also stress the importance of psychosocial support due to the dietary restrictions and their impact on quality of life. Future research is needed to improve non-endoscopic diagnostic techniques, understand the pathogenesis of EoE, and develop standardized tools for symptom severity and treatment response.

Keywords

Eosinophilic Esophagitis

BSG

BSPGHAN

Guidelines

Dysphagia

Biopsies

Proton Pump Inhibitors

Dietary Elimination

Topical Steroids

Psychosocial Support