Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference

Evan S. Dellon*, Chris A. Liacouras, Javier Molina-Infante, Glenn T. Furuta, Jonathan M. Spergel, Noam Zevit, Stuart J. Spechler, Stephen E. Attwood, Alex Straumann, Seema S. Aceves, Jeffrey A. Alexander, Dan Atkins, Nicoleta Catalina Arva, Carine Blanchard, Peter A. Bonis, Wendy M. Book, Kelley E. Capocelli, Mirna Chehade, Edaire Cheng, Margaret H. CollinsCarla M. Davis, Jorge A. Dias, Carlo Di Lorenzo, Ranjan Dohil, Christophe Dupont, Gary W. Falk, Cristina T. Ferreira, Adam Fox, Nirmala Prabu Gonsalves, Sandeep K. Gupta, David A. Katzka, Yoshikazu Kinoshita, Calies Menard-Katcher, Ellyn Kodroff, David C. Metz, Stephan Miehlke, Amanda B. Muir, Vincent A. Mukkada, Simon Murch, Samuel Nurko, Yoshikazu Ohtsuka, Rok Orel, Alexandra Papadopoulou, Kathryn A. Peterson, Hamish Philpott, Philip E. Putnam, Joel E. Richter, Rachel Rosen, Marc E. Rothenberg, Alain Schoepfer, Melissa M. Scott, Neil Shah, Javed Sheikh, Rhonda F. Souza, Mary J. Strobel, Nicholas J. Talley, Michael F. Vaezi, Yvan Vandenplas, Mario C. Vieira, Marjorie M. Walker, Joshua Brian Wechsler, Barry K Wershil, Ting Wen, Guang-Yu Yang, Ikuo Hirano, Albert J. Bredenoord

*Corresponding author for this work

Research output: Contribution to journalArticle

130 Scopus citations

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 languageEnglish (US)
Pages (from-to)1022-1033.e10
JournalGastroenterology
Volume155
Issue number4
DOIs
StatePublished - Oct 2018

Keywords

  • Diagnosis
  • Eosinophilic Esophagitis
  • Esophageal Eosinophilia
  • Proton Pump Inhibitor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Dellon, E. S., Liacouras, C. A., Molina-Infante, J., Furuta, G. T., Spergel, J. M., Zevit, N., Spechler, S. J., Attwood, S. E., Straumann, A., Aceves, S. S., Alexander, J. A., Atkins, D., Arva, N. C., Blanchard, C., Bonis, P. A., Book, W. M., Capocelli, K. E., Chehade, M., Cheng, E., ... Bredenoord, A. J. (2018). Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology, 155(4), 1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009