Gastroenterology
Volume 133, Issue 4 , Pages 1342-1363 , October 2007

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

  • Glenn T. Furuta

      Affiliations

    • Section of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital, Denver, University of Colorado Medical School, Denver, Colorado
    • Corresponding Author InformationAddress 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.
    • Dr Furuta’s current address is: The Children’s Hospital, 13123 East 16th Avenue, Aurora, Colorado 80045. fax: (720) 777-8025.
    • ,
  • Chris A. Liacouras

      Affiliations

    • Division of Gastroenterology, Hepatology, and Nutrition, University of Pennsylvania School of Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    • ,
  • Margaret H. Collins

      Affiliations

    • Division of Pathology, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
    • ,
  • Sandeep K. Gupta

      Affiliations

    • Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
    • ,
  • Chris Justinich

      Affiliations

    • Division of Pediatric Gastroenterology, Queen’s University, Kingston General Hospital, Kingston, Ontario, Canada
    • ,
  • Phil E. Putnam

      Affiliations

    • Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Peter Bonis

      Affiliations

    • Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
    • ,
  • Eric Hassall

      Affiliations

    • Division of Gastroenterology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Alex Straumann

      Affiliations

    • Department of Gastroenterology, University Hospital Basel, University Basel, Basel, Switzerland
    • ,
  • Marc E. Rothenberg

      Affiliations

    • Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Members of the First International Gastrointestinal Eosinophil Research Symposium (FIGERS) Subcommittees

      Affiliations

    • FIGERS Subcommittee listed in Appendix 1

  • Image Result

    Endoscopic findings associated with eosinophilic esophagitis. (A) Mucosal rings representative of transient contractions or fixed structures. This appearance has also been termed feline esophagus, tra

    Endoscopic findings associated with eosinophilic esophagitis. (A) Mucosal rings representative of transient contractions or fixed structures. This appearance has also been termed feline esophagus, trachealization, or concentric rings. (B) Whitish exudates scattered across the mucosal surface. These represent eosinophilic purulence burgeoning through the esophageal epithelium. Exudates can appear as punctate white nodules, dispersant flocculant material, or in a granular pattern and can occur along the length of the esophagus.

  • Image Result
    Esophageal furrowing representative of mucosal edema and thickening. (A) Furrows encompass the entire luminal surface of the distal esophagus with a very thick and almost nodular appearance. (B) In th

    Esophageal furrowing representative of mucosal edema and thickening. (A) Furrows encompass the entire luminal surface of the distal esophagus with a very thick and almost nodular appearance. (B) In this Figure, the most prominent furrowing occurs preferentially along the left lateral wall. (C) Vertical lines course along the length of the esophageal mucosa. This finding is often most prominent when the esophagus is inflated.

  • Image Result
    Eosinophilic esophageal inflammation in eosinophilic esophagitis. (A) Low-power view of the epithelium showing increased numbers of eosinophils and evidence of basal zone hyperplasia and elongated ret

    Eosinophilic esophageal inflammation in eosinophilic esophagitis. (A) Low-power view of the epithelium showing increased numbers of eosinophils and evidence of basal zone hyperplasia and elongated rete papillae. (B) High-power view of the epithelium demonstrating large numbers of eosinophils accumulating preferentially toward the luminal surface along with a thickened basal zone.

  • Image Result
    Eosinophilic microabscess associated with eosinophilic esophagitis. (A) Low-power view of an eosinophilic microabscess with superficial layering of eosinophils along the luminal surface. (B) Low-power

    Eosinophilic microabscess associated with eosinophilic esophagitis. (A) Low-power view of an eosinophilic microabscess with superficial layering of eosinophils along the luminal surface. (B) Low-power view of 2 massive eosinophil abscesses along luminal border of esophagus. These occur on a base of hyperplastic epithelium. (C) High-power view of eosinophil microabscess. Inferior to the abscess are a number of eosinophils, some of which appear degranulated.

 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

Gastroenterology
Volume 133, Issue 4 , Pages 1342-1363 , October 2007

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