EoE ToT Module 4 References-Liacouras et al J Allergy Clin Immunol 2011 Eosinophilic esophagitis Updated consensus recommendations for children and adults

Liacouras et al J Allergy Clin Immunol 2011 Eosinophilic esophagitis Updated consensus recommendations for children and adults

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The document presents updated consensus recommendations on the diagnosis and treatment of eosinophilic esophagitis (EoE) for both children and adults. It highlights significant advancements since a 2007 consensus, revealing new insights into the disease's pathophysiology, diagnostic criteria, and treatment options. <br /><br />EoE is recognized as a chronic, immune/antigen-mediated esophageal disease characterized by symptoms related to esophageal dysfunction and histologically by eosinophilic inflammation (15 eosinophils/high-power field minimum as diagnostic threshold). The disease frequently occurs alongside other allergic conditions such as asthma, food allergies, and eczema, suggesting its allergic component.<br /><br />The guidelines emphasize a multidisciplinary approach involving pediatric and adult gastroenterologists, allergists, and pathologists. Diagnosis is heavily reliant on endoscopic findings and histologic examination, necessitating biopsies from both the proximal and distal esophagus. Allergy evaluation, including skin patch and specific IgE tests, is advised to identify comorbid conditions and guide dietary interventions.<br /><br />For treatment, three main options are discussed: proton pump inhibitors (PPIs), dietary management, and corticosteroid therapy. PPIs can distinguish EoE from gastroesophageal reflux disease (GERD) and are beneficial for those with coinciding GERD and EoE. Dietary management via elemental diets, elimination diets based on allergy tests, or empirical food elimination has proven effectiveness, particularly in children. Topical corticosteroids (fluticasone and budesonide) remain crucial for inducing and maintaining remission, although long-term management requires monitoring for potential side effects, especially in children.<br /><br />Esophageal dilation is considered for patients with significant narrowing or symptomatic strictures, despite potential risks of perforation. The document calls for further studies on the genetic, histologic, and clinical aspects of EoE, with efforts aimed at improving diagnostic accuracy, treatment efficacy, and understanding the natural history and long-term complications of the disease. <br /><br />This comprehensive set of recommendations, developed by a panel of experts, aims to improve patient outcomes through enhanced diagnostic precision and targeted therapeutic strategies.

Keywords

eosinophilic esophagitis

EoE

diagnosis

treatment

children

adults

allergic conditions

dietary management

corticosteroid therapy

multidisciplinary approach