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
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.
Abbreviations used in this paper: EDN, eosinophil-derived neurotoxin, EE, eosinophilic esophagitis, eos/HPF, eosinophils per high-power field, GERD, gastroesophageal reflux disease, PPI, proton pump inhibitors
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.
PII: S0016-5085(07)01474-6
doi:10.1053/j.gastro.2007.08.017
© 2007 AGA Institute and North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Published by Elsevier Inc. All rights reserved.
