Eosinophilic Esophagitis in Children and Adults: A Systematic Review and Consensus Recommendations for Diagnosis and Treatment: Sponsored by the American Gastroenterological Association (AGA) Institute and North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition
published online 10 August 2007.
During the last decade, clinical practice saw a rapid increase of patients with esophageal eosinophilia who were thought to have gastroesophageal reflux disease (GERD) but who did not respond to medical and/or surgical GERD management. Subsequent studies demonstrated that these patients had a “new” disease termed eosinophilic esophagitis (EE). As recognition of EE grew, so did confusion surrounding diagnostic criteria and treatment. To address these issues, a multidisciplinary task force of 31 physicians assembled with the goal of determining diagnostic criteria and making recommendations for evaluation and treatment of children and adults with suspected EE. Consensus recommendations were based upon a systematic review of the literature and expert opinion. EE is a clinicopathological disease characterized by (1) Symptoms including but not restricted to food impaction and dysphagia in adults, and feeding intolerance and GERD symptoms in children; (2) ≥ 15 eosinophils/HPF; (3) Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD. (Use of high dose proton pump inhibitor treatment or normal pH monitoring). Appropriate treatments include dietary approaches based upon eliminating exposure to food allergens, or topical corticosteroids. Since EE is a relatively new disease, the intent of this report is to provide current recommendations for care of affected patients and defining gaps in knowledge for future research studies.
⁎Section of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital, Denver, University of Colorado Medical School, Denver, Colorado
‡Division of Gastroenterology, Hepatology, and Nutrition, University of Pennsylvania School of Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
§Division of Pathology, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
∥Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
¶Division of Pediatric Gastroenterology, Queen’s University, Kingston General Hospital, Kingston, Ontario, Canada
#Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
⁎⁎Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
‡‡Division of Gastroenterology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
§§Department of Gastroenterology, University Hospital Basel, University Basel, Basel, Switzerland
∥∥Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
Address requests for reprints to: Chair of the Clinical Practice and Quality Management Committee, American Gastroenterological Association (AGA) Institute, 4930 Del Ray Ave, Bethesda, Maryland 20814.
Supported by a small conference grant R13 DK076672 from the National Institutes of Health to The FIGER Symposium; North American Society of Pediatric Gastroenterology, Hepatology; the American Academy of Allergy, Asthma, and Immunology; The American Partnership for Eosinophilic Diseases; a philanthropic contribution from a grateful family; and educational grants (AstraZeneca, Abbot Laboratories, Nutricia, TAP, Ception, GlaxoSmithKline).
Conflict of interest disclosures: Glenn T. Furuta, consultant, Ception Therapeutics; speaker’s bureau, TAP; Chris A. Liacouras, consultant, SHS, Nutricia, Ception, Ross; grant/research support, Wyeth; speaker’s bureau, TAP, Merck; Margaret H. Collins, consultant, GlaxoSmithKline, Ception Therapeutics; Sandeep K. Gupta, consultant, GlaxoSmithKline, TAP, AstraZeneca, Salix; speaker’s bureau, Ross Products, TAP, AstraZeneca; educational grant, Ross Products; Christopher Justinich, no disclosures; Phil E. Putnam, no disclosures; Peter A Bonis, no disclosures; Eric Hassall, consultant, TAP Pharmaceuticals, Abbott Canada, Altana Pharma; clinical research grant, AstraZeneca; Alex Straumann, no disclosures; Marc E. Rothenberg, consultant, Merck, Ception Therapeutics, GlaxoSmithKline, MedaCorp; speaker’s bureau, Merck; Samuel Nurko, grant/research support, Wyeth pharmaceutica, TAP, Sucampo; Nirmala Gonsalves, consultant, Medacorp, Ception Therapeutics; Jonathan Markowitz, consultant, Ception Therapeutics; Don Antonioli, no disclosures; Eduardo Ruchelli, no disclosures; Hector Melin-Aldana, no disclosures; Margret Magid, no disclosures; Ikuo Hirano, no disclosures; David Katzka, no disclosures; Susan R. Orenstein, consultant, Ception Therapeutics, TAP, Braintree, AstraZeneca, Wyeth, Bristol Myers Squibb, McNeil; grant/research support, Braintree; Jonathan M. Spergel, consultant, Novartis, GlaxoSmithKline; grant/research support, Novartis, Nutricia; speaker’s bureau, AstraZeneca, GlaxoSmithKline; Amal Assa’ad, no disclosures; Seema Aceves, no disclosures; Barry K. Wershil, consultant, AP Pharmaceuticals, AstraZeneca; speaker’s bureau, Shire; educational grant, TAP Pharmaceuticals; Thomas Platts-Mills, no disclosures; Tusar Desai, no disclosures; Seema Khan, no disclosures; B Li, no disclosures; Amir F. Kagalwalla, no disclosures.
1 Dr Furuta’s current address is: The Children’s Hospital, 13123 East 16th Avenue, Aurora, Colorado 80045. fax: (720) 777-8025.
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