Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Academy of Allergy, Asthma & Immunology, American College of Allergy, Asthma, and Immunology, and American Gastroenterological Association.

Management of Eosinophilic Esophagitis

American College of Allergy, Asthma, and Immunology

American Academy of Allergy, Asthma & Immunology

American Gastroenterological Association

Publication Date: Apr 1, 2020

Page Last Updated: May 5, 2026

GRADE Strength of Recommendations and Implications

Grade	Quality of Evidence
High	We are very confident that the true effect lies close to the estimate of the effect.
Moderate	We are moderately confident that the true effect lies close to that of the estimate of the effect. There is a possibility that it is substantially different.
Low	Our confidence that the true effect lies close to that of the estimate of the effect is low. The true effect may be substantially different from the estimate of the effect.
Very low	We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
Evidence / Knowledge Gap	Available evidence insufficient to determine true effect.

Grade	Strength of Recommendation
Strong “AGA recommends...”	For the Patient	For the Clinician	For policy makers
Strong “AGA recommends...”	Most individuals in this situation would want the recommended course and only a small proportion would not.	Most individuals should receive the intervention. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	The recommendation can be adapted as policy or performance measure in most situations.
Conditional (weak) “AGA suggests...”	The majority of individuals in this situation would want the suggested course, but many would not.	Different choices will be appropriate for individual patients consistent with his or her values and preferences. Use shared decision making. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values, and preferences.	Policy making will require substantial debate and involvement of various stakeholders. Performance measures should assess whether decision making is appropriate.
No recommendation “AGA makes no recommendation...”		The confidence in the effect estimate is so low that any effect estimate is speculative at this time.

Document Overview

Document Title: Management of Eosinophilic Esophagitis

Authoring Societies

American College of Allergy, Asthma, and Immunology

American Academy of Allergy, Asthma & Immunology

American Gastroenterological Association

Document Publication Date: Apr 1, 2020

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.gastrojournal.org/article/S0016-5085(20)30265-1/fulltext

Source Citation: Ikuo Hirano, Edmond S. Chan, Matthew A. Rank, Rajiv Sharaf, Neil H. Stollman, David R. Stukus, Kenneth Wang, Matthew Greenhawt, Yngve Falck-Ytter. American Gastroenterological Association and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Ann Allergy Asthma Immunol. 2020;124:416-423.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This document presents the official recommendations of the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters (JTF) on the management of eosinophilic esophagitis.

Scope: Assessment and Screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH): D057765 - Eosinophilic Esophagitis

Keywords: allergic rhinitis, asthma, eczema, eosinophilic esophagitis, esophagogastroduodenoscopy (EGD), interleukin, proton pump inhibitor

Target Patient Population: patients with eosinophilic esophagitis

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory, Childcare Center, Emergency Care, Hospital

Intended Users: Dietician/Nutritionist, Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Should Repeat Esophagogastroduodenoscopy Be Used to Assess Patients With Eosinophilic Esophagitis After a Change in Treatment?
What Is the Management of Patients Who Become Asymptomatic After Initial Proton Pump Inhibitor Treatment?
Should Proton Pump Inhibitors Be Used in Patients With Esophageal Eosinophilia?
Should Topical Glucocorticosteroids Be Used in Patients With Eosinophilic Esophagitis?
Should Systemic Glucocorticosteroids Be Used in Patients With Eosinophilic Esophagitis?
Should an Elemental Diet Be Used in Patients With Eosinophilic Esophagitis?
Should an Empiric Food Elimination Diet Be Used in Patients With Eosinophilic Esophagitis?
Should Allergy-Based Testing Be Used for the Purpose of Identifying Food Triggers in Patients With Eosinophilic Esophagitis?
Should Maintenance Therapy Be Recommended in Patients With Eosinophilic Esophagitis?
Should Esophageal Dilation Be Used in Patients With Eosinophilic Esophagitis?
Should Anti–Interleukin-5 Therapy Be Used in Patients With Eosinophilic Esophagitis?
Should Anti–Interleukin-13 Therapy Be Used in Patients With Eosinophilic Esophagitis?
Should Anti-IgE Therapy Be Used in Patients With Eosinophilic Esophagitis?
Should Montelukast, Cromolyn, Immunomodulators, or Anti-TNF Therapy Be Used in Patients With Eosinophilic Esophagitis?

Supplemental Methodology Resource: Technical Review

Number of Source Documents: 135

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No