Abstract
Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1022-1033.e10 |
| Journal | Gastroenterology |
| Volume | 155 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 1 2018 |
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Keywords
- Diagnosis
- Eosinophilic Esophagitis
- Esophageal Eosinophilia
- Proton Pump Inhibitor
ASJC Scopus subject areas
- Hepatology
- Gastroenterology
Cite this
}
Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis : Proceedings of the AGREE Conference. / Dellon, Evan S.; Liacouras, Chris A.; Molina-Infante, Javier; Furuta, Glenn T.; Spergel, Jonathan M.; Zevit, Noam; Spechler, Stuart J.; Attwood, Stephen E.; Straumann, Alex; Aceves, Seema S.; Alexander, Jeffrey A.; Atkins, Dan; Arva, Nicoleta Catalina; Blanchard, Carine; Bonis, Peter A.; Book, Wendy M.; Capocelli, Kelley E.; Chehade, Mirna; Cheng, Edaire; Collins, Margaret H.; Davis, Carla M.; Dias, Jorge A.; Di Lorenzo, Carlo; Dohil, Ranjan; Dupont, Christophe; Falk, Gary W.; Ferreira, Cristina T.; Fox, Adam; Gonsalves, Nirmala Prabu; Gupta, Sandeep K.; Katzka, David A.; Kinoshita, Yoshikazu; Menard-Katcher, Calies; Kodroff, Ellyn; Metz, David C.; Miehlke, Stephan; Muir, Amanda B.; Mukkada, Vincent A.; Murch, Simon; Nurko, Samuel; Ohtsuka, Yoshikazu; Orel, Rok; Papadopoulou, Alexandra; Peterson, Kathryn A.; Philpott, Hamish; Putnam, Philip E.; Richter, Joel E.; Rosen, Rachel; Rothenberg, Marc E.; Schoepfer, Alain; Scott, Melissa M.; Shah, Neil; Sheikh, Javed; Souza, Rhonda F.; Strobel, Mary J.; Talley, Nicholas J.; Vaezi, Michael F.; Vandenplas, Yvan; Vieira, Mario C.; Walker, Marjorie M.; Wechsler, Joshua Brian; Wershil, Barry K; Wen, Ting; Yang, Guang-Yu; Hirano, Ikuo; Bredenoord, Albert J.
In: Gastroenterology, Vol. 155, No. 4, 01.10.2018, p. 1022-1033.e10.Research output: Contribution to journal › Article
TY - JOUR
T1 - Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis
T2 - Proceedings of the AGREE Conference
AU - Dellon, Evan S.
AU - Liacouras, Chris A.
AU - Molina-Infante, Javier
AU - Furuta, Glenn T.
AU - Spergel, Jonathan M.
AU - Zevit, Noam
AU - Spechler, Stuart J.
AU - Attwood, Stephen E.
AU - Straumann, Alex
AU - Aceves, Seema S.
AU - Alexander, Jeffrey A.
AU - Atkins, Dan
AU - Arva, Nicoleta Catalina
AU - Blanchard, Carine
AU - Bonis, Peter A.
AU - Book, Wendy M.
AU - Capocelli, Kelley E.
AU - Chehade, Mirna
AU - Cheng, Edaire
AU - Collins, Margaret H.
AU - Davis, Carla M.
AU - Dias, Jorge A.
AU - Di Lorenzo, Carlo
AU - Dohil, Ranjan
AU - Dupont, Christophe
AU - Falk, Gary W.
AU - Ferreira, Cristina T.
AU - Fox, Adam
AU - Gonsalves, Nirmala Prabu
AU - Gupta, Sandeep K.
AU - Katzka, David A.
AU - Kinoshita, Yoshikazu
AU - Menard-Katcher, Calies
AU - Kodroff, Ellyn
AU - Metz, David C.
AU - Miehlke, Stephan
AU - Muir, Amanda B.
AU - Mukkada, Vincent A.
AU - Murch, Simon
AU - Nurko, Samuel
AU - Ohtsuka, Yoshikazu
AU - Orel, Rok
AU - Papadopoulou, Alexandra
AU - Peterson, Kathryn A.
AU - Philpott, Hamish
AU - Putnam, Philip E.
AU - Richter, Joel E.
AU - Rosen, Rachel
AU - Rothenberg, Marc E.
AU - Schoepfer, Alain
AU - Scott, Melissa M.
AU - Shah, Neil
AU - Sheikh, Javed
AU - Souza, Rhonda F.
AU - Strobel, Mary J.
AU - Talley, Nicholas J.
AU - Vaezi, Michael F.
AU - Vandenplas, Yvan
AU - Vieira, Mario C.
AU - Walker, Marjorie M.
AU - Wechsler, Joshua Brian
AU - Wershil, Barry K
AU - Wen, Ting
AU - Yang, Guang-Yu
AU - Hirano, Ikuo
AU - Bredenoord, Albert J.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.
AB - Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.
KW - Diagnosis
KW - Eosinophilic Esophagitis
KW - Esophageal Eosinophilia
KW - Proton Pump Inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85053196870&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053196870&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2018.07.009
DO - 10.1053/j.gastro.2018.07.009
M3 - Article
C2 - 30009819
AN - SCOPUS:85053196870
VL - 155
SP - 1022-1033.e10
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 4
ER -