British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

doi:10.1136/gutjnl-2022-327326

. 2022 Aug;71(8):1459-1487.

doi: 10.1136/gutjnl-2022-327326. Epub 2022 May 23.

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Anjan Dhar^{1

2}, Hasan N Haboubi^{3

4}, Stephen E Attwood⁵, Marcus K H Auth^{6

7}, Jason M Dunn^{8

9}, Rami Sweis¹⁰, Danielle Morris¹¹, Jenny Epstein¹², Marco R Novelli¹³, Hannah Hunter¹⁴, Amanda Cordell¹⁵, Sharon Hall¹⁶, Jamal O Hayat¹⁷, Kapil Kapur¹⁸, Andrew Robert Moore¹⁹, Carol Read²⁰, Sarmed S Sami²¹, Paul J Turner^{22

23}, Nigel J Trudgill²⁴

Affiliations

¹ Gastroenterology, Darlington Memorial Hospital, Darlington, UK adhar@nhs.net.
² Teesside University, Middlesbrough, UK.
³ Cancer Biomarker Group, Swansea University, Swansea, UK.
⁴ Department of Gastroenterology, University Hospital Llandough, Llandough, UK.
⁵ Health Services Research, Durham University, Morpeth, Durham, UK.
⁶ Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
⁷ University of Liverpool, Liverpool, UK.
⁸ Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ Comprehensive Cancer Centre, King's College London, London, UK.
¹⁰ Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, UK.
¹¹ Department of Gastroenterology, East and North Hertfordshire NHS Trust, Stevenage, UK.
¹² Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
¹³ Histopathology, University College London, London, UK.
¹⁴ Department of Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁵ Trustee & Chair, EOS Network, Eosinophilic Disease Charity, London, UK.
¹⁶ Department of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK.
¹⁷ Gastroenterology, St George's Healthcare NHS Trust, London, UK.
¹⁸ Gastroenterology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK.
¹⁹ Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
²⁰ Medical advisor/Patient advocate, EOS Network, Eosinophilic Disease Charity, London, UK.
²¹ Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
²² National Heart and Lung Institute Section of Allergy and Clinical Immunology, London, UK.
²³ Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK.
²⁴ Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK.

PMID: 35606089
PMCID: PMC9279848
DOI: 10.1136/gutjnl-2022-327326

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Anjan Dhar et al. Gut. 2022 Aug.

. 2022 Aug;71(8):1459-1487.

doi: 10.1136/gutjnl-2022-327326. Epub 2022 May 23.

Authors

Affiliations

¹ Gastroenterology, Darlington Memorial Hospital, Darlington, UK adhar@nhs.net.
² Teesside University, Middlesbrough, UK.
³ Cancer Biomarker Group, Swansea University, Swansea, UK.
⁴ Department of Gastroenterology, University Hospital Llandough, Llandough, UK.
⁵ Health Services Research, Durham University, Morpeth, Durham, UK.
⁶ Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
⁷ University of Liverpool, Liverpool, UK.
⁸ Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ Comprehensive Cancer Centre, King's College London, London, UK.
¹⁰ Research Department of Tissue and Energy, Division of Surgery & Interventional Science, University College London, London, UK.
¹¹ Department of Gastroenterology, East and North Hertfordshire NHS Trust, Stevenage, UK.
¹² Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
¹³ Histopathology, University College London, London, UK.
¹⁴ Department of Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁵ Trustee & Chair, EOS Network, Eosinophilic Disease Charity, London, UK.
¹⁶ Department of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK.
¹⁷ Gastroenterology, St George's Healthcare NHS Trust, London, UK.
¹⁸ Gastroenterology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK.
¹⁹ Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
²⁰ Medical advisor/Patient advocate, EOS Network, Eosinophilic Disease Charity, London, UK.
²¹ Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
²² National Heart and Lung Institute Section of Allergy and Clinical Immunology, London, UK.
²³ Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK.
²⁴ Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK.

PMID: 35606089
PMCID: PMC9279848
DOI: 10.1136/gutjnl-2022-327326

Abstract

Background: Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.

Methods: The Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.

Results: Fifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.

Conclusions: These comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

Keywords: DIET; DYSPHAGIA; ENDOSCOPY; OESOPHAGEAL DISEASE; PAEDIATRIC GASTROENTEROLOGY.

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Conflict of interest statement

Competing interests: See Supplementary Table 1.

Figures

**Figure 1**
Flow chart of guideline development process. GDG, guideline development group; PICO, Population, Intervention, Comparator, Outcome.

**Figure 2**
Eosinophilic oesophagitis diagnostic algorithm in emergency and elective settings. EoE, eosinophilic oesophagitis; GORD, gastro-oesophageal reflux disease; PPI, proton pump inhibitor.

**Figure 3**
Eosinophilic oesophagitis management algorithm in adults and children. PPI, proton pump inhibitor.

**Figure 4**
Dietary management of eosinophilic oesophagitis in children (grey) and adults. EoE, eosinophilic oesophagitis; PPI, proton pump inhibitor.

See this image and copyright information in PMC

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References

1. Attwood SE, Smyrk TC, Demeester TR, et al. . Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993;38:109–16. 10.1007/BF01296781 - DOI - PubMed
1. Straumann A, Spichtin HP, Bernoulli R. [Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. Schweiz Med Wochenschr 1994;124:1419–29. - PubMed
1. Lucendo AJ, Molina-Infante J, Arias Ángel, et al. . Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5:335–58. 10.1177/2050640616689525 - DOI - PMC - PubMed
1. Hirano I, Chan ES, Rank MA, et al. . AGA Institute and the joint Task force on Allergy-Immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Gastroenterology 2020;158:1776–86. 10.1053/j.gastro.2020.02.038 - DOI - PMC - PubMed
1. Guyatt GH, Oxman AD, Vist GE, et al. . Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6. 10.1136/bmj.39489.470347.AD - DOI - PMC - PubMed

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[1] Attwood SE, Smyrk TC, Demeester TR, et al. . Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993;38:109–16. 10.1007/BF01296781 - DOI - PubMed

[2] Attwood SE, Smyrk TC, Demeester TR, et al. . Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993;38:109–16. 10.1007/BF01296781 - DOI - PubMed

[3] Straumann A, Spichtin HP, Bernoulli R. [Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. Schweiz Med Wochenschr 1994;124:1419–29. - PubMed

[4] Straumann A, Spichtin HP, Bernoulli R. [Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. Schweiz Med Wochenschr 1994;124:1419–29. - PubMed

[5] Lucendo AJ, Molina-Infante J, Arias Ángel, et al. . Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5:335–58. 10.1177/2050640616689525 - DOI - PMC - PubMed

[6] Lucendo AJ, Molina-Infante J, Arias Ángel, et al. . Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5:335–58. 10.1177/2050640616689525 - DOI - PMC - PubMed

[7] Hirano I, Chan ES, Rank MA, et al. . AGA Institute and the joint Task force on Allergy-Immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Gastroenterology 2020;158:1776–86. 10.1053/j.gastro.2020.02.038 - DOI - PMC - PubMed

[8] Hirano I, Chan ES, Rank MA, et al. . AGA Institute and the joint Task force on Allergy-Immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Gastroenterology 2020;158:1776–86. 10.1053/j.gastro.2020.02.038 - DOI - PMC - PubMed

[9] Guyatt GH, Oxman AD, Vist GE, et al. . Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6. 10.1136/bmj.39489.470347.AD - DOI - PMC - PubMed

[10] Guyatt GH, Oxman AD, Vist GE, et al. . Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6. 10.1136/bmj.39489.470347.AD - DOI - PMC - PubMed

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British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Affiliations

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

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