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
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Overview
Title
Management of Eosinophilic Esophagitis
Authoring Organizations
American College of Allergy, Asthma, and Immunology
American Academy of Allergy, Asthma & Immunology
American Gastroenterological Association
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