Guidance developed for diagnosis, management of eosinophilic esophagitis

In a clinical guideline issued by the American College of Gastroenterology and published in the January issue of the American Journal of Gastroenterology, recommendations are presented for the diagnosis and management of eosinophilic esophagitis (EoE).

Evan S. Dellon, M.D., M.P.H., from the University of North Carolina School of Medicine in Chapel Hill, and colleagues made recommendations across domains of diagnosis, treatment, monitoring, and assessment of response and pediatric-specific considerations for EoE.

The authors recommend that EoE is diagnosed based on the presence of symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field on esophageal biopsy. A systematic endoscopic scoring system is recommended to characterize endoscopic findings of EoE at every endoscopy.

To assess for histologic features consistent with EoE, at least six esophageal biopsies from at least two esophageal levels should be obtained. Eosinophil counts should be quantified on esophageal biopsies from every endoscopy performed. Proton pump inhibitors (PPIs) are suggested as a treatment for EoE, while swallowed topical steroids are recommended as a treatment.

Use of either fluticasone propionate or budesonide is suggested for patients with EoE treated with topical steroids. An empiric food elimination diet is suggested for EoE treatment, but currently available allergy testing to direct food elimination diets is not suggested.

Dupilumab is suggested for individuals aged 12 years or older and for pediatric patients who are nonresponsive to PPI therapy. Omalizumab is not suggested for EoE treatment. For esophageal strictures causing dysphagia, endoscopic dilation is suggested as an adjunct to medical therapy.

“For all treatments, cost and insurance coverage should be considered on an individual basis because there are scant cost-effectiveness data to currently support decisions,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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