Management of Eosinophilic Esophagitis: AGA/JTF Guidelines

ARLINGTON HEIGHTS, Ill – (April 28, 2020) — A new guideline from the American Gastroenterological Association (AGA) and the Joint Task Force for Allergy-Immunology Practice Parameters provides recommendations for the management of Eosinophilic Esophagitis (EoE) in pediatric and adult patients. The new guideline focusses on clinical management and will guide allergists and gastroenterologists. The guidelines have been published in the Annals of Allergy, Asthma, and Immunology.

EoE is a chronic inflammatory disease of the esophagus triggered by allergens, which causes difficulty with swallowing in adults. It grows more frequent and intense over time and affects patients' quality of life. Children experience varied symptoms that include feeding difficulty, pain, vomiting, as well as dysphagia. EoE affects an estimated one in 2,000 people.

Key guideline highlights:

1. Topical Steroids are recommended as a first-line treatment for Eosinophilic Esophagitis. 

2. The guideline also recommends proton pump inhibition (PPI) therapy, diet therapy, and esophageal dilation as treatment options.

3. The use of novel, targeted biologic therapies for Eosinophilic Esophagitis are being actively evaluated and more research is needed before these can be recommended.

"Over the past two decades, EoE has emerged as a dominant cause of swallowing difficulties worldwide," said Ikuo Hirano, MD, AGAF, a gastroenterologist from Northwestern University Feinberg School of Medicine and lead guideline author. "The recommendations we've outlined will guide allergists and gastroenterologists in effectively managing their patients' EoE and improving their quality of life. As the field moves forward, a deeper understanding of the natural history of EoE in both children and adults is needed to inform clinical decisions regarding the optimal use of disease monitoring and long-term, maintenance therapy."

This guideline was developed through a collaboration between AGA and the Joint Task Force for Allergy-Immunology Practice Parameters, which comprises the American College of Allergy, Asthma & Immunology (ACAAI) and the American Academy of Allergy, Asthma & Immunology. The guideline is jointly published in Gastroenterology, the official journal of the AGA Institute, and Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma & Immunology. 

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DOI:https://doi.org/10.1016/j.anai.2020.03.020