Module 9 References-Lucendo et al UEGJ 2017 Guidelines on EoE Diagnosis and management in children and adults

Lucendo et al UEGJ 2017 Guidelines on EoE Diagnosis and management in children and adults

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The article outlines the updated guidelines for the diagnosis and management of Eosinophilic Esophagitis (EoE) in children and adults, shaped by extensive research and expert collaboration. EoE, a chronic immune-mediated disease, leads to esophageal dysfunction and inflammation primarily characterized by an excess of eosinophils. The guidelines were formulated using the AGREE II methodology and GRADE system to ensure high standards of evidence.<br /><br />Key updates include a refined definition of EoE, emphasizing that clinical and histological remission may be achieved through proton pump inhibitors (PPIs), topical steroids, and elimination diets. The guidelines highlight the transition away from defining EoE by its response to PPIs, now treated as a therapeutic agent rather than a diagnostic criterion, reflecting new genetic and clinical evidence equating PPI-responsive esophageal eosinophilia with EoE.<br /><br />The document includes specific recommendations:<br />1. A minimum of six biopsies from different esophageal locations should be taken for diagnosis.<br />2. The diagnostic threshold is set at 15 eosinophils per high-power field.<br />3. Non-invasive biomarkers are currently not accurate for diagnosis or monitoring.<br />4. Clinical symptoms alone do not reliably indicate disease activity; histological assessment remains essential.<br />5. Effective long-term management involves sustained avoidance of identified food triggers or ongoing pharmacological therapy.<br /><br />Treatment recommendations encompass:<br />1. PPIs, topical corticosteroids, and dietary interventions as first-line therapies.<br />2. Endoscopic dilation for patients with persistent dysphagia or food impaction refractory to other treatments.<br />3. Limited use of systemic steroids due to potential side effects.<br />4. Specific advice on the cautious use of new and emerging treatments, pending further research.<br /><br />The guidelines underscore the chronic and progressive nature of EoE, stressing continuous monitoring to prevent long-term complications such as esophageal strictures. These guidelines are intended for multi-disciplinary use and prioritizes individualized patient care, educational outreach, and broader dissemination across Europe.

Keywords

Eosinophilic Esophagitis

EoE

diagnosis

management

proton pump inhibitors

biopsies

histological assessment

dietary interventions

endoscopic dilation

chronic disease