Management of Eosinophilic Esophagitis

Publication Date: April 1, 2020

Recommendations 

In patients with symptomatic esophageal eosinophilia, the AGA/JTF suggests using proton pump inhibition over no treatment. ( Very Low , Conditional (weak) )
612
In patients with EoE, the AGA/JTF recommends topical glucocorticosteroids over no treatment. (Moderate, Strong)
612
In patients with EoE, the AGA/JTF suggests topical glucocorticosteroids rather than oral glucocorticosteroids. (Moderate, Conditional (weak))
612
In patients with EoE, the AGA/JTF suggests using elemental diet over no treatment. (Moderate, Conditional (weak))
  • Comment: Patients who put a higher value on avoiding the challenges of adherence to an elemental diet and the prolonged process of dietary reintroduction may reasonably decline this treatment option.
612
In patients with EoE, the AGA/JTF suggests using an empiric, 6-food elimination diet over no treatment. (Low, Conditional (weak))
Comment: Patients who put a higher value on avoiding the challenges of adherence to diet involving elimination of multiple common food staples and the prolonged process of dietary reintroduction may reasonably decline this treatment option.
612
In patients with EoE, the AGA/JTF suggests using an allergy testing-based elimination diet over no treatment. (Very Low, Conditional (weak))
  • Comment: Due to the potential limited accuracy of currently available, allergy-based testing for the identification of specific food triggers for EoE, patients may prefer alternative medical or dietary therapies to an exclusively testing-based elimination diet.
612
In patient with EoE in remission after short-term use of topical glucocorticosteroids, the AGA/JTF suggests continuation of topical glucocorticosteroids over discontinuation of treatment. ( Very Low , Conditional (weak) )
  • Patients who put a high value on the avoidance of long-term topical steroid use and its possible associated adverse effects, and/or place a lower value on the prevention of potential long-term undesirable outcomes (ie, recurrent dysphagia, food impaction, and esophageal stricture), could reasonably prefer cessation of treatment after initial remission is achieved, provided clinical follow-up is maintained.
612
In adult patients with dysphagia from a stricture associated with EoE, the AGA/JTF suggests endoscopic dilation over no dilation. ( Very Low , Conditional (weak) )
  • Esophageal dilation does not address the esophageal inflammation associated with EoE.
612
In patients with EoE, the AGA/JTF recommends using anti–IL-5 therapy for EoE only in the context of a clinical trial. ( Evidence Gap , No recommendation )
612
In patients with EoE, the AGA/JTF recommends using anti–IL-13 or anti–IL-4 receptor α therapy for EoE only in the context of a clinical trial. ( Evidence Gap , No recommendation )
612
In patients with EoE, the AGA/JTF suggests against the use of anti-IgE therapy for EoE. ( Very Low , Conditional (weak) )
612
In patients with EoE the AGA/JTF suggest using montelukast, cromolyn sodium, immunomodulators, and anti-TNF for EoE only in the context of a clinical trial. ( Evidence Gap , Conditional (weak) )
612

Recommendation Grading

Disclaimer

Overview

Title

Management of Eosinophilic Esophagitis

Authoring Organizations

Publication Month/Year

April 1, 2020

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Childcare center, Emergency care, Hospital

Intended Users

Physician, dietician nutritionist, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D057765 - Eosinophilic Esophagitis

Keywords

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

Supplemental Methodology Resources

Technical Review