Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4–12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti–interleukin-5 therapy, anti–interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.
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Conflicts of interest: The authors disclose the following: Dr Rank is supported by the Robert E. and Patricia D. Kern Center for the Science of Healthcare Delivery at Mayo Clinic and the Levin Family Foundation. Dr Sharaf is supported by the National Cancer Institute (NCI) 1K07CA216326-01A1 and NCI R01 1R01CA211723-01A1. Dr Furuta is supported by the LaCache Chair from Children's Hospital Colorado 1K24DK100303 and Consortium for Gastrointestinal Eosinophilic Researchers (CEGIR). CEGIR (U54 AI117804) is part of the Rare Diseases Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), and is funded through collaboration between National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and NCATS and American Partnership for Eosinophilic Disorders (APFED), Campaign Urging Research for Eosinophilic Disease (CURED) and Eosinophil Family Coalition (EFC). Dr Aceves is supported by R01, K24 AI, NIAID, and CEGIR. CEGIR (U54 AI117804) is part of the RDCRN, an initiative of the ORDR, NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS and APFED, CURED and EFC. Dr Aceves is also a consultant for Aimmune and Gossamer, and a co-inventor of oral viscous budesonide patented by University of California-San Diego and licenses by Shire-Takeda, and received funding from the National Institutes of Health. Dr Greenhawt is supported by grant #5K08HS024599-02 from the Agency for Healthcare Quality and Research. Dr Spergel is supported by the CEGIR. CEGIR (U54 AI117804) is part of the RDCRN, an initiative of the ORDR, NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS and APFED, CURED, and EFC and Stuart Starr Chair of Pediatrics. Dr Dellon is supported by National Institutes of Health grant R01DK101856, received research support from Adare, Allakos, GSK, Meritage, Nutricia, Celgene/Receptos, Regeneron, Shire. Dr Dellon also received consulting support from Abbot, Adare, Allakos, Arena, AstraZeneca, Biorasi, Calypso, Celgene/Receptos, Eli Lilly, EsoCap, Gossamer Bio, GSK, Regeneron, Robarts, Salix, Shire/Takeda, and received educational support from Allakos, Banner, and Holoclara. The remaining authors disclose no conflicts.
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, P.H.S.