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Review
. 2018 Oct;155(4):1022-1033.e10.
doi: 10.1053/j.gastro.2018.07.009. Epub 2018 Sep 6.

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

Evan S Dellon  1 , Chris A Liacouras  2 , Javier Molina-Infante  3 , Glenn T Furuta  4 , Jonathan M Spergel  5 , Noam Zevit  6 , Stuart J Spechler  7 , Stephen E Attwood  8 , Alex Straumann  9 , Seema S Aceves  10 , Jeffrey A Alexander  11 , Dan Atkins  12 , Nicoleta C Arva  13 , Carine Blanchard  14 , Peter A Bonis  15 , Wendy M Book  16 , Kelley E Capocelli  17 , Mirna Chehade  18 , Edaire Cheng  19 , Margaret H Collins  20 , Carla M Davis  21 , Jorge A Dias  22 , Carlo Di Lorenzo  23 , Ranjan Dohil  24 , Christophe Dupont  25 , Gary W Falk  26 , Cristina T Ferreira  27 , Adam Fox  28 , Nirmala P Gonsalves  29 , Sandeep K Gupta  30 , David A Katzka  11 , Yoshikazu Kinoshita  31 , Calies Menard-Katcher  4 , Ellyn Kodroff  32 , David C Metz  26 , Stephan Miehlke  33 , Amanda B Muir  2 , Vincent A Mukkada  34 , Simon Murch  35 , Samuel Nurko  36 , Yoshikazu Ohtsuka  37 , Rok Orel  38 , Alexandra Papadopoulou  39 , Kathryn A Peterson  40 , Hamish Philpott  41 , Philip E Putnam  34 , Joel E Richter  42 , Rachel Rosen  43 , Marc E Rothenberg  44 , Alain Schoepfer  45 , Melissa M Scott  46 , Neil Shah  47 , Javed Sheikh  48 , Rhonda F Souza  7 , Mary J Strobel  16 , Nicholas J Talley  49 , Michael F Vaezi  50 , Yvan Vandenplas  51 , Mario C Vieira  52 , Marjorie M Walker  53 , Joshua B Wechsler  54 , Barry K Wershil  54 , Ting Wen  44 , Guang-Yu Yang  55 , Ikuo Hirano  29 , Albert J Bredenoord  56
Affiliations
Review

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

Evan S Dellon et al. Gastroenterology. 2018 Oct.

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.

Keywords: Diagnosis; Eosinophilic Esophagitis; Esophageal Eosinophilia; Proton Pump Inhibitor.

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Figures

Figure 1.
Figure 1.
Updated EoE diagnostic algorithm.
See this image and copyright information in PMC

Comment in

  • A new acronym for PPI-REE?
    Hopp R. Hopp R. Ann Allergy Asthma Immunol. 2018 Dec;121(6):747. doi: 10.1016/j.anai.2018.10.003. Ann Allergy Asthma Immunol. 2018. PMID: 30502820 No abstract available.

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