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

62 Citations (Scopus)

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 1 2018

Fingerprint

Eosinophilic Esophagitis
Proton Pump Inhibitors
Consensus
Eosinophilia
Eosinophils
Telecommunications
Esophagitis
Gastroenterology
Hypersensitivity
Therapeutics
Communication
Research Personnel
Guidelines
Pediatrics
Pathology
Physicians
Biopsy

Keywords

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

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Dellon, E. S., Liacouras, C. A., Molina-Infante, J., Furuta, G. T., Spergel, J. M., Zevit, N., ... 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
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. / Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis : Proceedings of the AGREE Conference. In: Gastroenterology. 2018 ; Vol. 155, No. 4. pp. 1022-1033.e10.
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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.",
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Dellon, ES, Liacouras, CA, Molina-Infante, J, Furuta, GT, Spergel, JM, Zevit, N, Spechler, SJ, Attwood, SE, Straumann, A, Aceves, SS, Alexander, JA, Atkins, D, Arva, NC, Blanchard, C, Bonis, PA, Book, WM, Capocelli, KE, Chehade, M, Cheng, E, Collins, MH, Davis, CM, Dias, JA, Di Lorenzo, C, Dohil, R, Dupont, C, Falk, GW, Ferreira, CT, Fox, A, Gonsalves, NP, Gupta, SK, Katzka, DA, Kinoshita, Y, Menard-Katcher, C, Kodroff, E, Metz, DC, Miehlke, S, Muir, AB, Mukkada, VA, Murch, S, Nurko, S, Ohtsuka, Y, Orel, R, Papadopoulou, A, Peterson, KA, Philpott, H, Putnam, PE, Richter, JE, Rosen, R, Rothenberg, ME, Schoepfer, A, Scott, MM, Shah, N, Sheikh, J, Souza, RF, Strobel, MJ, Talley, NJ, Vaezi, MF, Vandenplas, Y, Vieira, MC, Walker, MM, Wechsler, JB, Wershil, BK, Wen, T, Yang, G-Y, Hirano, I & Bredenoord, AJ 2018, 'Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference', Gastroenterology, vol. 155, no. 4, pp. 1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009

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 journalArticle

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

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U2 - 10.1053/j.gastro.2018.07.009

DO - 10.1053/j.gastro.2018.07.009

M3 - Article

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Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018 Oct 1;155(4):1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009