23
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. This underlines the importance of optimizing diagnosys and treatment of the condition, especially after the increasing amount of knowledge on EoE recently published. Therefore, the UEG, EAACI ESPGHAN, and EUREOS deemed it necessary to update the current guidelines regarding conceptual and epidemiological aspects, diagnosis, and treatment of EoE.

          Methods

          General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted up to August 2015 and periodically updated. The working group consisted of gastroenterologists, allergists, pediatricians, otolaryngologists, pathologists, and epidemiologists. Systematic evidence-based reviews were performed based upon relevant clinical questions with respect to patient-important outcomes.

          Results

          The guidelines include updated concept of EoE, evaluated information on disease epidemiology, risk factors, associated conditions, and natural history of EoE in children and adults. Diagnostic conditions and criteria, the yield of diagnostic and disease monitoring procedures, and evidence-based statements and recommendation on the utility of the several treatment options for patients EoE are provided. Recommendations on how to choose and implement treatment and long-term management are provided based on expert opinion and best clinical practice.

          Conclusion

          Evidence-based recommendations for EoE diagnosis, treatment modalities, and patients’ follow up are proposed in the guideline.

          Related collections

          Most cited references12

          • Record: found
          • Abstract: found
          • Article: not found

          ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE).

          Esophageal eosinophilia and eosinophilic esophagitis (EoE) are increasingly recognized and prevalent conditions, which now represent common clinical problems encountered by gastroenterologists, pathologists, and allergists. The study of EoE has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Although there are limited data supporting management decisions, clinical parameters are needed to guide the care of patients with eosinophilic-esophageal disorders. In this evidence-based review, recommendations developed by adult and pediatric gastroenterologists are provided for the evaluation and management of these patients. New terminology is emphasized, particularly the concepts of esophageal eosinophilia and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) as entities distinct from EoE.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Esophageal eosinophilia with dysphagia

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.

              Consensus diagnostic recommendations to distinguish GORD from eosinophilic oesophagitis (EoE) by response to a trial of proton pump inhibitors (PPIs) unexpectedly uncovered an entity called 'PPI-responsive oesophageal eosinophilia' (PPI-REE). PPI-REE refers to patients with clinical and histological features of EoE that remit with PPI treatment. Recent and evolving evidence, mostly from adults, shows that patients with PPI-REE and patients with EoE at baseline are clinically, endoscopically and histologically indistinguishable and have a significant overlap in terms of features of Th2 immune-mediated inflammation and gene expression. Furthermore, PPI therapy restores oesophageal mucosal integrity, reduces Th2 inflammation and reverses the abnormal gene expression signature in patients with PPI-REE, similar to the effects of topical steroids in patients with EoE. Additionally, recent series have reported that patients with EoE responsive to diet/topical steroids may also achieve remission on PPI therapy. This mounting evidence supports the concept that PPI-REE represents a continuum of the same immunological mechanisms that underlie EoE. Accordingly, it seems counterintuitive to differentiate PPI-REE from EoE based on a differential response to PPI therapy when their phenotypic, molecular, mechanistic and therapeutic features cannot be reliably distinguished. For patients with symptoms and histological features of EoE, it is reasonable to consider PPI therapy not as a diagnostic test, but as a therapeutic agent. Due to its safety profile, ease of administration and high response rates (up to 50%), PPI can be considered a first-line treatment before diet and topical steroids. The reasons why some patients with EoE respond to PPI, while others do not, remain to be elucidated.
                Bookmark

                Author and article information

                Journal
                United European Gastroenterol J
                United European Gastroenterol J
                UEG
                spueg
                United European Gastroenterology Journal
                SAGE Publications (Sage UK: London, England )
                2050-6406
                2050-6414
                23 January 2017
                April 2017
                : 5
                : 3
                : 335-358
                Affiliations
                [1 ]Department of Gastroenterology, Hospital General de Tomelloso, Servicio de Salud de Castilla-La Mancha, Tomelloso, Spain
                [2 ]Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
                [3 ]Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain
                [4 ]Research Support Unit, Hospital General Mancha Centro, Alcázar de San Juan, Spain
                [5 ]Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
                [6 ]Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands
                [7 ]Pathologie Viollier, Basel, Switzerland
                [8 ]Department of Pediatrics, Hospital S. João, Porto, Portugal
                [9 ]Department of ENT, Head and Neck Surgery, NÄL Medical Centre, Trollhättan, Sweden
                [10 ]Department of Allergy, Hospital General de Tomelloso, Tomelloso, Spain
                [11 ]Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
                [12 ]Division of Pediatric Gastroenterology and Hepatology, Athens Children’s Hospital “Agia Sofia”, University of Athens, Athens, Greece
                [13 ]Department of Gastroenterology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
                [14 ]University Department of Pediatrics, Children’s Hospital – Spedali Civili, Brescia, Italy
                [15 ]Center for Life Course Health Research, University of Oulu, Tornio, Finland
                [16 ]Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
                [17 ]Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
                [18 ]Center of Endoscopy, Starnberg, Germany
                [19 ]Department of ENT, Amsterdam Medical Centre, Amsterdam, the Netherlands
                [20 ]Swiss EoE Clinics, Olten, Switzerland
                [21 ]Department of Health Services Research, Durham University, UK
                Author notes
                [*]Alfredo J Lucendo, Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n, 13700 Tomelloso, Spain. Email: ajlucendo@ 123456hotmail.com
                Article
                PMC5415218 PMC5415218 5415218 10.1177_2050640616689525
                10.1177/2050640616689525
                5415218
                28507746
                a862abb6-c38c-42a8-9e8d-dc0b587adf47
                © Author(s) 2017
                History
                : 14 November 2016
                : 26 December 2016
                Categories
                Review Articles

                consensus development conferences,Eosinophilic esophagitis,guidelines,evidence-based practice

                Comments

                Comment on this article