ACG Updates Guidelines for Eosinophilic Esophagitis: Daily Dose

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Last week, we reported on updated guidelines issued by the American College of Gastroenterology (ACG) for diagnosing, treating, and monitoring eosinophilic esophagitis (EoE) published in the American Journal of Gastroenterology.

The methods

Researchers used the Grading of Recommendations, Assessment, Development and Evaluation framework to develop 19 recommendations related to the diagnosis, management, and monitoring of people with EoE. They additionally addressed concerns related to maintenance therapy and considerations for pediatric patients.

Each recommendation accounted for the quality of evidence, risks versus benefits, feasibility, and cost as well as perceived patient and population-based factors. The terms “recommendations” and “suggestions” indicated strong and conditional recommendations, respectively.

Key recommendations

• The ACG recommends EoE be diagnosed based on symptoms of esophageal dysfunction and the presence of at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy, after ruling out other disorders that may cause eosinophilia.

• The ACG recommends the use of a systematic endoscopic scoring system, such as the EoE Endoscopic Reference Score, during each endoscopy to characterize findings.

• The ACG recommends at least 6 esophageal biopsies from at least 2 levels (proximal/mid and distal) should be obtained to assess for histologic features consistent with EoE.

• The ACG suggests the use of proton pump inhibitors (PPIs) and recommends the use of swallowed topical steroids (eg, fluticasone propionate or budesonide) for the treatment of EoE.

• The ACG suggests the use of dupilumab for both pediatric patients (1-11 years) and those aged 12 years and older who are nonresponsive to PPI therapy.

• The ACG recommends evaluating treatment response through symptomatic, endoscopic, and histologic outcomes assessment.

• The ACG suggests enlisting a feeding therapist and/or dietitian as an adjunctive therapy intervention for children with EoE and feeding dysfunction.

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