Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practi...
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| Veröffentlicht in: | Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2020-05, Vol.158 (6), p.1789-1810.e15 |
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| creator | Rank, Matthew A. Sharaf, Rajiv N. Furuta, Glenn T. Aceves, Seema S. Greenhawt, Matthew Spergel, Jonathan M. Falck-Ytter, Yngve T. Dellon, Evan S. Chachu, Karen A. Day, Lukejohn Lebwohl, Benjamin Muniraj, Thiruvengadam Patel, Amit Peery, Anne F. Shah, Raj Singh, Harminder Singh, Siddharth Spechler, Stuart J. Sultan, Shahnaz Su, Grace L. Thrift, Aaron P. Weiss, Jennifer M. Weizman, Adam V. Bernstein, Jonathan A. Dinakar, Chitra Golden, David B.K. Khan, David A. Lieberman, Jay Oppenheimer, John Shaker, Marcus Stukus, David R. Wallace, Dana V. Wang, Julie |
| description | Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to |
| doi_str_mv | 10.1053/j.gastro.2020.02.039 |
| format | Article |
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Electronic address: clinicalpractice@gastro.org ; Joint Task Force on Allergy-Immunology Practice Parameters collaborators. Electronic address: drdanawallace@gmail.com</creatorcontrib><description>Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4–12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti–interleukin-5 therapy, anti–interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/j.gastro.2020.02.039</identifier><identifier>PMID: 32359563</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Administration, Topical ; Adult ; Advisory Committees - standards ; Age Factors ; Allergy and Immunology - organization & administration ; Allergy and Immunology - standards ; Biologic Therapy ; Child ; Corticosteroids ; Dietary Therapy ; Dilatation - adverse effects ; Dilatation - standards ; Elemental Diet ; Elimination Diet ; Eosinophilic Esophagitis ; Eosinophilic Esophagitis - diagnosis ; Eosinophilic Esophagitis - immunology ; Eosinophilic Esophagitis - therapy ; Eosinophils - drug effects ; Eosinophils - immunology ; Esophageal Dilation ; Esophagoscopy - adverse effects ; Esophagoscopy - standards ; Evidence-Based Medicine - methods ; Evidence-Based Medicine - standards ; Food Hypersensitivity - complications ; Food Hypersensitivity - diagnosis ; Food Hypersensitivity - diet therapy ; Food Hypersensitivity - immunology ; Food, Formulated ; Gastroenterology - methods ; Gastroenterology - organization & administration ; Gastroenterology - standards ; Glucocorticoids - administration & dosage ; Humans ; Proton Pump Inhibitor ; Proton Pump Inhibitors - therapeutic use ; Societies, Medical - organization & administration ; Societies, Medical - standards ; Swallowed Corticosteroids ; Targeted Elimination Diet ; Technical Review ; Treatment Outcome ; United States</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2020-05, Vol.158 (6), p.1789-1810.e15</ispartof><rights>2020 AGA Institute</rights><rights>Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-95b2aab5873c9d0a7c991432e60c148db3e56ff00b42c1e6ded848fd21f00d693</citedby><cites>FETCH-LOGICAL-c529t-95b2aab5873c9d0a7c991432e60c148db3e56ff00b42c1e6ded848fd21f00d693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016508520302663$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32359563$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rank, Matthew A.</creatorcontrib><creatorcontrib>Sharaf, Rajiv N.</creatorcontrib><creatorcontrib>Furuta, Glenn T.</creatorcontrib><creatorcontrib>Aceves, Seema S.</creatorcontrib><creatorcontrib>Greenhawt, Matthew</creatorcontrib><creatorcontrib>Spergel, Jonathan M.</creatorcontrib><creatorcontrib>Falck-Ytter, Yngve T.</creatorcontrib><creatorcontrib>Dellon, Evan S.</creatorcontrib><creatorcontrib>Chachu, Karen A.</creatorcontrib><creatorcontrib>Day, Lukejohn</creatorcontrib><creatorcontrib>Lebwohl, Benjamin</creatorcontrib><creatorcontrib>Muniraj, Thiruvengadam</creatorcontrib><creatorcontrib>Patel, Amit</creatorcontrib><creatorcontrib>Peery, Anne F.</creatorcontrib><creatorcontrib>Shah, Raj</creatorcontrib><creatorcontrib>Singh, Harminder</creatorcontrib><creatorcontrib>Singh, Siddharth</creatorcontrib><creatorcontrib>Spechler, Stuart J.</creatorcontrib><creatorcontrib>Sultan, Shahnaz</creatorcontrib><creatorcontrib>Su, Grace L.</creatorcontrib><creatorcontrib>Thrift, Aaron P.</creatorcontrib><creatorcontrib>Weiss, Jennifer M.</creatorcontrib><creatorcontrib>Weizman, Adam V.</creatorcontrib><creatorcontrib>Bernstein, Jonathan A.</creatorcontrib><creatorcontrib>Dinakar, Chitra</creatorcontrib><creatorcontrib>Golden, David B.K.</creatorcontrib><creatorcontrib>Khan, David A.</creatorcontrib><creatorcontrib>Lieberman, Jay</creatorcontrib><creatorcontrib>Oppenheimer, John</creatorcontrib><creatorcontrib>Shaker, Marcus</creatorcontrib><creatorcontrib>Stukus, David R.</creatorcontrib><creatorcontrib>Wallace, Dana V.</creatorcontrib><creatorcontrib>Wang, Julie</creatorcontrib><creatorcontrib>AGA Institute</creatorcontrib><creatorcontrib>Joint Task Force on Allergy-Immunology Practice Parameters collaborators</creatorcontrib><creatorcontrib>AGA Institute. Electronic address: clinicalpractice@gastro.org</creatorcontrib><creatorcontrib>Joint Task Force on Allergy-Immunology Practice Parameters collaborators. Electronic address: drdanawallace@gmail.com</creatorcontrib><title>Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><description>Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4–12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti–interleukin-5 therapy, anti–interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.</description><subject>Administration, Topical</subject><subject>Adult</subject><subject>Advisory Committees - standards</subject><subject>Age Factors</subject><subject>Allergy and Immunology - organization & administration</subject><subject>Allergy and Immunology - standards</subject><subject>Biologic Therapy</subject><subject>Child</subject><subject>Corticosteroids</subject><subject>Dietary Therapy</subject><subject>Dilatation - adverse effects</subject><subject>Dilatation - standards</subject><subject>Elemental Diet</subject><subject>Elimination Diet</subject><subject>Eosinophilic Esophagitis</subject><subject>Eosinophilic Esophagitis - diagnosis</subject><subject>Eosinophilic Esophagitis - immunology</subject><subject>Eosinophilic Esophagitis - therapy</subject><subject>Eosinophils - drug effects</subject><subject>Eosinophils - immunology</subject><subject>Esophageal Dilation</subject><subject>Esophagoscopy - adverse effects</subject><subject>Esophagoscopy - standards</subject><subject>Evidence-Based Medicine - methods</subject><subject>Evidence-Based Medicine - standards</subject><subject>Food Hypersensitivity - complications</subject><subject>Food Hypersensitivity - diagnosis</subject><subject>Food Hypersensitivity - diet therapy</subject><subject>Food Hypersensitivity - immunology</subject><subject>Food, Formulated</subject><subject>Gastroenterology - methods</subject><subject>Gastroenterology - organization & administration</subject><subject>Gastroenterology - standards</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Humans</subject><subject>Proton Pump Inhibitor</subject><subject>Proton Pump Inhibitors - therapeutic use</subject><subject>Societies, Medical - organization & administration</subject><subject>Societies, Medical - standards</subject><subject>Swallowed Corticosteroids</subject><subject>Targeted Elimination Diet</subject><subject>Technical Review</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0016-5085</issn><issn>1528-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Ud1u0zAUjhCIlcEbIORLbhL8E6cxF0jV1G5FQ0yoXFuOc5K6JHaxnU19HZ507joG3HB1rHO-n3P8ZdlbgguCOfuwK3oVoncFxRQXmBaYiWfZjHBa5xgT-jybpVLlHNf8LHsVwg5jLFhNXmZnjDIueMVm2a8N6K01Wg3oG9wauEPOorgF9EVZ1cMINiLXoaULxrr91gxGo2VIL9WbaMJHtEi8vfMRrbwbH5iLywVa2xBNnCIgZduH7mdnktRGhR9o5byGo89iGMD3h3w9jpN1g-sP6MYrHU0a3yivRojgw-vsRaeGAG8e63n2fbXcXFzl118v1xeL61xzKmIueEOVang9Z1q0WM21EKRkFCqsSVm3DQNedR3GTUk1gaqFti7rrqUk9dpKsPPs00l3PzUjtDqd7tUg996Myh-kU0b-O7FmK3t3K0U5Z4TzJPD-UcC7nxOEKEcTNAyDsuCmICkT9RFHywQtT1DtXQgeuicbguUxXrmTp3jlMV6JqUzxJtq7v1d8Iv3O888NkD4qxell0AashtZ40FG2zvzf4R5iS7vn</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>Rank, Matthew A.</creator><creator>Sharaf, Rajiv N.</creator><creator>Furuta, Glenn T.</creator><creator>Aceves, Seema S.</creator><creator>Greenhawt, Matthew</creator><creator>Spergel, Jonathan M.</creator><creator>Falck-Ytter, Yngve T.</creator><creator>Dellon, Evan S.</creator><creator>Chachu, Karen A.</creator><creator>Day, Lukejohn</creator><creator>Lebwohl, Benjamin</creator><creator>Muniraj, Thiruvengadam</creator><creator>Patel, Amit</creator><creator>Peery, Anne F.</creator><creator>Shah, Raj</creator><creator>Singh, Harminder</creator><creator>Singh, Siddharth</creator><creator>Spechler, Stuart J.</creator><creator>Sultan, Shahnaz</creator><creator>Su, Grace L.</creator><creator>Thrift, Aaron P.</creator><creator>Weiss, Jennifer M.</creator><creator>Weizman, Adam V.</creator><creator>Bernstein, Jonathan A.</creator><creator>Dinakar, Chitra</creator><creator>Golden, David B.K.</creator><creator>Khan, David A.</creator><creator>Lieberman, Jay</creator><creator>Oppenheimer, John</creator><creator>Shaker, Marcus</creator><creator>Stukus, David R.</creator><creator>Wallace, Dana V.</creator><creator>Wang, Julie</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202005</creationdate><title>Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters</title><author>Rank, Matthew A. ; 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Electronic address: drdanawallace@gmail.com</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rank, Matthew A.</au><au>Sharaf, Rajiv N.</au><au>Furuta, Glenn T.</au><au>Aceves, Seema S.</au><au>Greenhawt, Matthew</au><au>Spergel, Jonathan M.</au><au>Falck-Ytter, Yngve T.</au><au>Dellon, Evan S.</au><au>Chachu, Karen A.</au><au>Day, Lukejohn</au><au>Lebwohl, Benjamin</au><au>Muniraj, Thiruvengadam</au><au>Patel, Amit</au><au>Peery, Anne F.</au><au>Shah, Raj</au><au>Singh, Harminder</au><au>Singh, Siddharth</au><au>Spechler, Stuart J.</au><au>Sultan, Shahnaz</au><au>Su, Grace L.</au><au>Thrift, Aaron P.</au><au>Weiss, Jennifer M.</au><au>Weizman, Adam V.</au><au>Bernstein, Jonathan A.</au><au>Dinakar, Chitra</au><au>Golden, David B.K.</au><au>Khan, David A.</au><au>Lieberman, Jay</au><au>Oppenheimer, John</au><au>Shaker, Marcus</au><au>Stukus, David R.</au><au>Wallace, Dana V.</au><au>Wang, Julie</au><aucorp>AGA Institute</aucorp><aucorp>Joint Task Force on Allergy-Immunology Practice Parameters collaborators</aucorp><aucorp>AGA Institute. Electronic address: clinicalpractice@gastro.org</aucorp><aucorp>Joint Task Force on Allergy-Immunology Practice Parameters collaborators. Electronic address: drdanawallace@gmail.com</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters</atitle><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle><addtitle>Gastroenterology</addtitle><date>2020-05</date><risdate>2020</risdate><volume>158</volume><issue>6</issue><spage>1789</spage><epage>1810.e15</epage><pages>1789-1810.e15</pages><issn>0016-5085</issn><eissn>1528-0012</eissn><abstract>Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4–12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti–interleukin-5 therapy, anti–interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32359563</pmid><doi>10.1053/j.gastro.2020.02.039</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0016-5085 |
| ispartof | Gastroenterology (New York, N.Y. 1943), 2020-05, Vol.158 (6), p.1789-1810.e15 |
| issn | 0016-5085 1528-0012 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9473155 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Alma/SFX Local Collection |
| subjects | Administration, Topical Adult Advisory Committees - standards Age Factors Allergy and Immunology - organization & administration Allergy and Immunology - standards Biologic Therapy Child Corticosteroids Dietary Therapy Dilatation - adverse effects Dilatation - standards Elemental Diet Elimination Diet Eosinophilic Esophagitis Eosinophilic Esophagitis - diagnosis Eosinophilic Esophagitis - immunology Eosinophilic Esophagitis - therapy Eosinophils - drug effects Eosinophils - immunology Esophageal Dilation Esophagoscopy - adverse effects Esophagoscopy - standards Evidence-Based Medicine - methods Evidence-Based Medicine - standards Food Hypersensitivity - complications Food Hypersensitivity - diagnosis Food Hypersensitivity - diet therapy Food Hypersensitivity - immunology Food, Formulated Gastroenterology - methods Gastroenterology - organization & administration Gastroenterology - standards Glucocorticoids - administration & dosage Humans Proton Pump Inhibitor Proton Pump Inhibitors - therapeutic use Societies, Medical - organization & administration Societies, Medical - standards Swallowed Corticosteroids Targeted Elimination Diet Technical Review Treatment Outcome United States |
| title | Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T23%3A23%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Technical%20Review%20on%20the%20Management%20of%20Eosinophilic%20Esophagitis:%20A%20Report%20From%20the%20AGA%20Institute%20and%20the%20Joint%20Task%20Force%20on%20Allergy-Immunology%20Practice%20Parameters&rft.jtitle=Gastroenterology%20(New%20York,%20N.Y.%201943)&rft.au=Rank,%20Matthew%20A.&rft.aucorp=AGA%20Institute&rft.date=2020-05&rft.volume=158&rft.issue=6&rft.spage=1789&rft.epage=1810.e15&rft.pages=1789-1810.e15&rft.issn=0016-5085&rft.eissn=1528-0012&rft_id=info:doi/10.1053/j.gastro.2020.02.039&rft_dat=%3Cproquest_pubme%3E2398155324%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2398155324&rft_id=info:pmid/32359563&rft_els_id=S0016508520302663&rfr_iscdi=true |