Subject(s)
Allergy and Immunology/standards , Eosinophilic Esophagitis/therapy , Gastroenterology/standards , Advisory Committees/standards , Allergy and Immunology/organization & administration , Eosinophilic Esophagitis/immunology , Gastroenterology/methods , Gastroenterology/organization & administration , Humans , Societies, Medical/organization & administration , Societies, Medical/standards , United StatesABSTRACT
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.
Subject(s)
Eosinophilic Esophagitis/therapy , Evidence-Based Medicine/standards , Food Hypersensitivity/diagnosis , Administration, Topical , Adult , Advisory Committees/standards , Age Factors , Allergy and Immunology/organization & administration , Allergy and Immunology/standards , Child , Dilatation/adverse effects , Dilatation/standards , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/immunology , Eosinophils/drug effects , Eosinophils/immunology , Esophagoscopy/adverse effects , Esophagoscopy/standards , Evidence-Based Medicine/methods , Food Hypersensitivity/complications , Food Hypersensitivity/diet therapy , Food Hypersensitivity/immunology , Food, Formulated , Gastroenterology/methods , Gastroenterology/organization & administration , Gastroenterology/standards , Glucocorticoids/administration & dosage , Humans , Proton Pump Inhibitors/therapeutic use , Societies, Medical/organization & administration , Societies, Medical/standards , Treatment Outcome , United StatesSubject(s)
Adrenal Cortex Hormones/therapeutic use , Allergy and Immunology , Eosinophilic Esophagitis/drug therapy , Proton Pump Inhibitors/therapeutic use , Administration, Topical , Advisory Committees , Disease Progression , Eosinophilic Esophagitis/diagnosis , Expert Testimony , Humans , Phenotype , Practice Guidelines as Topic , United StatesABSTRACT
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.