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

doi:10.1053/j.gastro.2018.07.009

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 Dellon¹, Chris A Liacouras², Javier Molina-Infante³, Glenn T Furuta⁴, Jonathan M Spergel⁵, Noam Zevit⁶, Stuart J Spechler⁷, Stephen E Attwood⁸, Alex Straumann⁹, Seema S Aceves¹⁰, Jeffrey A Alexander¹¹, Dan Atkins¹², Nicoleta C Arva¹³, Carine Blanchard¹⁴, Peter A Bonis¹⁵, Wendy M Book¹⁶, Kelley E Capocelli¹⁷, Mirna Chehade¹⁸, Edaire Cheng¹⁹, Margaret H Collins²⁰, Carla M Davis²¹, Jorge A Dias²², Carlo Di Lorenzo²³, Ranjan Dohil²⁴, Christophe Dupont²⁵, Gary W Falk²⁶, Cristina T Ferreira²⁷, Adam Fox²⁸, Nirmala P Gonsalves²⁹, Sandeep K Gupta³⁰, David A Katzka¹¹, Yoshikazu Kinoshita³¹, Calies Menard-Katcher⁴, Ellyn Kodroff³², David C Metz²⁶, Stephan Miehlke³³, Amanda B Muir², Vincent A Mukkada³⁴, Simon Murch³⁵, Samuel Nurko³⁶, Yoshikazu Ohtsuka³⁷, Rok Orel³⁸, Alexandra Papadopoulou³⁹, Kathryn A Peterson⁴⁰, Hamish Philpott⁴¹, Philip E Putnam³⁴, Joel E Richter⁴², Rachel Rosen⁴³, Marc E Rothenberg⁴⁴, Alain Schoepfer⁴⁵, Melissa M Scott⁴⁶, Neil Shah⁴⁷, Javed Sheikh⁴⁸, Rhonda F Souza⁷, Mary J Strobel¹⁶, Nicholas J Talley⁴⁹, Michael F Vaezi⁵⁰, Yvan Vandenplas⁵¹, Mario C Vieira⁵², Marjorie M Walker⁵³, Joshua B Wechsler⁵⁴, Barry K Wershil⁵⁴, Ting Wen⁴⁴, Guang-Yu Yang⁵⁵, Ikuo Hirano²⁹, Albert J Bredenoord⁵⁶

Affiliations

¹ Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: edellon@med.unc.edu.
² Center for Pediatric Eosinophilic Diseases, Division of Gastroenterology and Hepatology & Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
³ Department of Gastroenterology, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain and Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
⁴ Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado.
⁵ Center for Pediatric Eosinophilic Diseases, Division of Allergy-Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.
⁶ Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
⁷ Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas.
⁸ Department of Health Services Research, Durham University, Durham, UK.
⁹ Swiss EoE Research Network, Olten, Switzerland.
¹⁰ Division of Allergy, Immunology, Departments of Pediatrics and Medicine, University of California-San Diego and Rady Children's Hospital, San Diego, La Jolla, California.
¹¹ Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
¹² Allergy & Immunology Section, Children's Hospital Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado.
¹³ Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
¹⁴ Institute of Nutritional Science, Nestlé Research Center, Vevey, Switzerland.
¹⁵ Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts.
¹⁶ American Partnership for Eosinophilic Disorders, Atlanta, Georgia.
¹⁷ Department of Pediatric Pathology, Children's Hospital Colorado, Aurora, Colorado.
¹⁸ Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁹ Departments of Pediatrics and Internal Medicine, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas.
²⁰ Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²¹ Allergy and Immunology Section of the Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
²² Pediatric Gastroenterology, Centro Hospitalar S. João, Porto, Portugal.
²³ Division of Gastroenterology and Hepatology & Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
²⁴ Division of Gastroenterology and Hepatology, University of California-San Diego, Rady Children's Hospital, San Diego, California.
²⁵ Necker Hospital, Paris-Descartes University, Paris, France.
²⁶ Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
²⁷ Federal University of Health Sciences of Porto Alegre, Hospital Santo Antônio, Porto Alegre, RS, Brazil.
²⁸ Department of Paediatric Allergy, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
²⁹ Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois.
³⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Illinois, University of Illinois, Peoria, Illinois.
³¹ Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan.
³² Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, Illinois.
³³ Centre for Digestive Diseases, Internal Medicine Center, Eppendorf, Hamburg, Germany.
³⁴ Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³⁵ Department of Paediatrics, University Hospital Coventry & Warwickshire, Coventry, UK.
³⁶ Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts.
³⁷ Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
³⁸ University of Ljubljana, Faculty of Medicine, University Children's Hospital, Ljubljana, Slovenia.
³⁹ Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sofia, Athens, Greece.
⁴⁰ University of Utah, Salt Lake City, Utah.
⁴¹ Northern Adelaide Local Health Network, Department of Gastroenterology, University of Adelaide, South Australia.
⁴² University of South Florida Morsani College of Medicine, Tampa, Florida.
⁴³ Aerodigestive Center, Boston Children's Hospital, Boston, Massachusetts.
⁴⁴ Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁴⁵ Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
⁴⁶ Eosinophilic Family Coalition, Cincinnati, Ohio.
⁴⁷ Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
⁴⁸ Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
⁴⁹ Faculty of Health and Medicine, University of Newcastle, Australia.
⁵⁰ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee.
⁵¹ KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
⁵² Department of Pediatrics, Pontifical University of Paraná and Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil.
⁵³ Anatomical Pathology University of Newcastle Faculty of Health and Medicine School of Medicine and Public Health Callaghan, New South Wales, Australia.
⁵⁴ Eosinophilic Gastrointestinal Diseases Program, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
⁵⁵ Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois.
⁵⁶ Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 30009819
PMCID: PMC6174113
DOI: 10.1053/j.gastro.2018.07.009

Review

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

Evan S Dellon et al. Gastroenterology. 2018 Oct.

. 2018 Oct;155(4):1022-1033.e10.

doi: 10.1053/j.gastro.2018.07.009. Epub 2018 Sep 6.

Authors

Affiliations

¹ Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: edellon@med.unc.edu.
² Center for Pediatric Eosinophilic Diseases, Division of Gastroenterology and Hepatology & Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
³ Department of Gastroenterology, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain and Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
⁴ Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado.
⁵ Center for Pediatric Eosinophilic Diseases, Division of Allergy-Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.
⁶ Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
⁷ Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas.
⁸ Department of Health Services Research, Durham University, Durham, UK.
⁹ Swiss EoE Research Network, Olten, Switzerland.
¹⁰ Division of Allergy, Immunology, Departments of Pediatrics and Medicine, University of California-San Diego and Rady Children's Hospital, San Diego, La Jolla, California.
¹¹ Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
¹² Allergy & Immunology Section, Children's Hospital Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado.
¹³ Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
¹⁴ Institute of Nutritional Science, Nestlé Research Center, Vevey, Switzerland.
¹⁵ Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts.
¹⁶ American Partnership for Eosinophilic Disorders, Atlanta, Georgia.
¹⁷ Department of Pediatric Pathology, Children's Hospital Colorado, Aurora, Colorado.
¹⁸ Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁹ Departments of Pediatrics and Internal Medicine, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas.
²⁰ Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²¹ Allergy and Immunology Section of the Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
²² Pediatric Gastroenterology, Centro Hospitalar S. João, Porto, Portugal.
²³ Division of Gastroenterology and Hepatology & Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
²⁴ Division of Gastroenterology and Hepatology, University of California-San Diego, Rady Children's Hospital, San Diego, California.
²⁵ Necker Hospital, Paris-Descartes University, Paris, France.
²⁶ Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
²⁷ Federal University of Health Sciences of Porto Alegre, Hospital Santo Antônio, Porto Alegre, RS, Brazil.
²⁸ Department of Paediatric Allergy, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
²⁹ Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois.
³⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Illinois, University of Illinois, Peoria, Illinois.
³¹ Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan.
³² Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, Illinois.
³³ Centre for Digestive Diseases, Internal Medicine Center, Eppendorf, Hamburg, Germany.
³⁴ Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³⁵ Department of Paediatrics, University Hospital Coventry & Warwickshire, Coventry, UK.
³⁶ Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts.
³⁷ Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
³⁸ University of Ljubljana, Faculty of Medicine, University Children's Hospital, Ljubljana, Slovenia.
³⁹ Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sofia, Athens, Greece.
⁴⁰ University of Utah, Salt Lake City, Utah.
⁴¹ Northern Adelaide Local Health Network, Department of Gastroenterology, University of Adelaide, South Australia.
⁴² University of South Florida Morsani College of Medicine, Tampa, Florida.
⁴³ Aerodigestive Center, Boston Children's Hospital, Boston, Massachusetts.
⁴⁴ Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁴⁵ Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
⁴⁶ Eosinophilic Family Coalition, Cincinnati, Ohio.
⁴⁷ Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
⁴⁸ Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
⁴⁹ Faculty of Health and Medicine, University of Newcastle, Australia.
⁵⁰ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee.
⁵¹ KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
⁵² Department of Pediatrics, Pontifical University of Paraná and Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil.
⁵³ Anatomical Pathology University of Newcastle Faculty of Health and Medicine School of Medicine and Public Health Callaghan, New South Wales, Australia.
⁵⁴ Eosinophilic Gastrointestinal Diseases Program, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
⁵⁵ Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois.
⁵⁶ Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 30009819
PMCID: PMC6174113
DOI: 10.1053/j.gastro.2018.07.009

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.**
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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Spergel JM, Dellon ES, Liacouras CA, Hirano I, Molina-Infante J, Bredenoord AJ, Furuta GT; participants of AGREE. Spergel JM, et al. Ann Allergy Asthma Immunol. 2018 Sep;121(3):281-284. doi: 10.1016/j.anai.2018.05.035. Epub 2018 Jul 18. Ann Allergy Asthma Immunol. 2018. PMID: 30030146 Free PMC article. No abstract available.

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References

1. Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ. Variability in diagnostic criteria for eosinophilic esophagitis: A systematic review. Am J Gastroenterol 2007;102:2300–13. - PubMed
1. Sperry SL, Shaheen NJ, Dellon ES. Toward uniformity in the diagnosis of eosinophilic esophagitis (EoE): the effect of guidelines on variability of diagnostic criteria for EoE. Am J Gastroenterol 2011;106:824–32; quiz 833. - PubMed
1. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, Bonis P, Hassall E, Straumann A, Rothenberg ME. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342–63. - PubMed
1. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3–20. e6. - PubMed
1. Ngo P, Furuta GT, Antonioli DA, Fox VL. Eosinophils in the esophagus--peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol 2006;101:1666–70. - PubMed

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[1] Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ. Variability in diagnostic criteria for eosinophilic esophagitis: A systematic review. Am J Gastroenterol 2007;102:2300–13. - PubMed

[2] Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ. Variability in diagnostic criteria for eosinophilic esophagitis: A systematic review. Am J Gastroenterol 2007;102:2300–13. - PubMed

[3] Sperry SL, Shaheen NJ, Dellon ES. Toward uniformity in the diagnosis of eosinophilic esophagitis (EoE): the effect of guidelines on variability of diagnostic criteria for EoE. Am J Gastroenterol 2011;106:824–32; quiz 833. - PubMed

[4] Sperry SL, Shaheen NJ, Dellon ES. Toward uniformity in the diagnosis of eosinophilic esophagitis (EoE): the effect of guidelines on variability of diagnostic criteria for EoE. Am J Gastroenterol 2011;106:824–32; quiz 833. - PubMed

[5] Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, Bonis P, Hassall E, Straumann A, Rothenberg ME. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342–63. - PubMed

[6] Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, Bonis P, Hassall E, Straumann A, Rothenberg ME. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342–63. - PubMed

[7] Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3–20. e6. - PubMed

[8] Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3–20. e6. - PubMed

[9] Ngo P, Furuta GT, Antonioli DA, Fox VL. Eosinophils in the esophagus--peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol 2006;101:1666–70. - PubMed

[10] Ngo P, Furuta GT, Antonioli DA, Fox VL. Eosinophils in the esophagus--peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol 2006;101:1666–70. - PubMed

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

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

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