ACG updates clinical guideline for EoE ahead of ‘more advances in the coming years’
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Key takeaways:
- The ACG developed 19 recommendations related to the diagnosis and management of eosinophilic esophagitis.
- Guideline panel members also considered pediatric-specific concerns such as feeding dysfunction.
Considering “paradigm-shifting changes” in the diagnosis and management of eosinophilic esophagitis, the ACG released an updated guideline on treatment, monitoring and maintenance as well as pediatric-specific recommendations.
“This ACG clinical guideline is an update of the 2013 version,” Evan S. Dellon, MD, MPH, FACG, director of the Center for Esophageal Diseases and Swallowing at UNC School of Medicine, and colleagues wrote in the American Journal of Gastroenterology. “Since that time, there have been paradigm-shifting changes in disease diagnosis and management, increases in knowledge about EoE risk factors, natural history and pathogenesis, development of validated outcome metrics, a disease severity classification system and updated nomenclature.”
Dellon and colleagues used the Grading of Recommendations, Assessment, Development and Evaluation framework to develop 19 recommendations related to the diagnosis, management and monitoring of patients with EoE. They additionally addressed concerns related to maintenance therapy and considerations for pediatric patients.
Each recommendation accounted for the quality of evidence, risks vs. benefits, feasibility and cost as well as perceived patient and population-based factors. The terms “recommendations” and “suggestions” indicated strong and conditional recommendations, respectively.
Highlights from the ACG’s updated clinical guideline for the diagnosis and management of patients with EoE follow.
- The ACG recommends EoE be diagnosed based on symptoms of esophageal dysfunction and 15 or more eosinophils per high-power field on esophageal biopsy following evaluation for non-EoE disorders.
- The ACG recommends the use of a systematic endoscopic scoring system at each endoscopy to describe findings. To assess for histologic features, the ACG additionally recommends obtaining “at least” six biopsies from “at least” two esophageal levels.
- The ACG suggests the use of proton pump inhibitors and recommends the use of swallowed topical steroids for the treatment of EoE.
- The ACG suggest either fluticasone propionate or budesonide for those treated with topical steroids.
- The ACG suggests the use of dupilumab for both pediatric patients (1-11 years) and those aged 12 years and older who are nonresponsive to PPIs.
- The ACG recommends evaluating treatment response through symptomatic, endoscopic and histologic outcomes assessment.
- The ACG suggests enlisting a feeding therapist and/or dietitian as an adjunctive therapy intervention for children with EoE and feeding dysfunction.
“During the evidence review and writing process for these guidelines, knowledge gaps and areas for future research were identified,” Dellon and colleagues wrote. “Despite these needs, tremendous advancements have been made in the field over the past decade to the benefit of both patients and providers, and the field is poised for more advances in the coming years.”
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