Module 9 References-Liacouras et al J Allergy Clin Immunol 2011 Eosiniphilic esophagitis Updated consensus recommendations for children and adults

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

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The article comprehensively updates the consensus guidelines for diagnosing and managing Eosinophilic Esophagitis (EoE) in both children and adults. EoE is recognized as a chronic, immune/antigen-mediated esophageal disease, characterized by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. Diagnosis now requires both clinical symptoms and esophageal biopsy confirming eosinophils above 15 per high-power field (hpf).<br /><br />The updated diagnostic guidelines stress the importance of differentiating EoE from other causes of esophageal eosinophilia, such as GERD, often utilizing proton pump inhibitors (PPIs) to discern if eosinophilic esophagitis is PPI-responsive. Definitive EoE diagnosis still relies on both clinical and histopathologic findings, where endoscopy with biopsy remains the gold standard.<br /><br />Esophageal biopsies should be obtained from both the proximal and distal regions to maximize diagnostic yield. Multiple biopsies are recommended, given the patchy nature of eosinophilic infiltration. Important histologic features include eosinophil density, microabscesses, surface layering of eosinophils, and lamina propria fibrosis.<br /><br />Therapeutically, the recommendations highlight three main strategies: dietary elimination, use of topical corticosteroids, and esophageal dilation for certain complications such as strictures. Dietary interventions include amino acid-based formulas and allergen-specific food elimination, based on allergy testing. Topical steroids like fluticasone and budesonide are effective for inducing and maintaining remission, though they often require chronic use. Systemic steroids are reserved for severe cases due to potential side effects.<br /><br />Complications of EoE, such as food impaction and esophageal strictures, necessitate careful management, which might include endoscopic dilation. However, the procedure carries risks like perforation, underscoring the need for skilled and cautious execution.<br /><br />Looking forward, research to refine genetic markers of susceptibility, better diagnostic criteria, and less invasive monitoring techniques are identified as priorities. Understanding PPI-responsive esophageal eosinophilia and establishing more reliable biomarkers for disease activity remain critical goals.<br /><br />Overall, the updated guidelines aim to enhance diagnostic accuracy, improve patient outcomes through tailored therapeutic approaches, and drive future research to address unresolved clinical questions.

Keywords

Eosinophilic Esophagitis

EoE diagnosis

esophageal biopsy

proton pump inhibitors

dietary elimination

topical corticosteroids

esophageal dilation

histopathologic findings

food impaction

genetic markers