ACG Clinical Guideline: Evidenced Based Approach to the Diagnosis and Management of Esophageal Eosinophilia and Eosinophilic Esophagitis (EoE)

Liacouras, 2003, Eosinophilic esophagitis in children and adults., J Pediatr Gastroenterol Nutr, 37, S23, 10.1097/00005176-200311001-00006

Kapel, 2008, Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups., Gastroenterology, 134, 1316, 10.1053/j.gastro.2008.02.016

Rothenberg, 2001, Pathogenesis and clinical features of eosinophilic esophagitis., J Allergy Clin Immunol, 108, 891, 10.1067/mai.2001.120095

Rothenberg, 2010, Common variants at 5q22 associate with pediatric eosinophilic esophagitis., Nat Genet, 42, 289, 10.1038/ng.547

Blanchard, 2006, Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis., J Clin Invest, 116, 536, 10.1172/JCI26679

Schaefer, 2008, Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children., Clin Gastroenterol Hepatol, 6, 165, 10.1016/j.cgh.2007.11.008

Dohil, 2010, Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial., Gastroenterology, 139, 418, 10.1053/j.gastro.2010.05.001

Spergel, 2009, 14 years of eosinophilic esophagitis: clinical features and prognosis., J Pediatr Gastroenterol Nutr, 48, 30, 10.1097/MPG.0b013e3181788282

Jung, 2011, Occurrence of and risk factors for complications after endoscopic dilation in eosinophilic esophagitis., Gastrointest Endosc, 73, 15, 10.1016/j.gie.2010.09.036

Dellon, 2010, Esophageal dilation in eosinophilic esophagitis: safety and predictors of clinical response and complications., Gastrointest Endosc, 71, 706, 10.1016/j.gie.2009.10.047

Hirano, 2010, Dilation in eosinophilic esophagitis: to do or not to do?, Gastrointest Endosc, 71, 713, 10.1016/j.gie.2009.12.026

Guyatt, 2008, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations., BMJ, 336, 924, 10.1136/bmj.39489.470347.AD

Odze, 2009, Pathology of eosinophilic esophagitis: what the clinician needs to know., Am J Gastroenterol, 104, 485, 10.1038/ajg.2008.40

Ngo, 2006, Eosinophils in the esophaguspeptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia., Am J Gastroenterol, 101, 1666, 10.1111/j.1572-0241.2006.00562.x

Rodrigo, 2008, High intraepithelial eosinophil counts in esophageal squamous epithelium are not specific for eosinophilic esophagitis in adults., Am J Gastroenterol, 103, 435, 10.1111/j.1572-0241.2007.01594.x

Molina-Infante, 2009, Eosinophilic esophagitis in GERD patients: a clinicopathological diagnosis using protein pump inhibitors., Am J Gastroenterol, 104, 2856, 10.1038/ajg.2009.468

Attwood, 1993, Esophageal eosinophilia with dysphagia. a distinct clinicopathologic syndrome., Dig Dis Sci, 38, 109, 10.1007/BF01296781

Straumann, 1994, Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings., Schweiz Med Wochenschr, 124, 1419

Kelly, 1995, Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula., Gastroenterology, 109, 1503, 10.1016/0016-5085(95)90637-1

Rothenberg, 2009, Biology and treatment of eosinophilic esophagitis., Gastroenterology, 137, 1238, 10.1053/j.gastro.2009.07.007

Furuta, 2007, Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment., Gastroenterology, 133, 1342, 10.1053/j.gastro.2007.08.017

Prasad, 2007, Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study., Am J Gastroenterol, 102, 2627, 10.1111/j.1572-0241.2007.01512.x

Sperry, 2012, Influence of race and gender on the presentation of eosinophilic esophagitis., Am J Gastroenterol, 107, 215, 10.1038/ajg.2011.342

Bohm, 2012, Mucosal eosinophilia: prevalence and racialethnic differences in symptoms and endoscopic findings in adults over 10 years in an urban hospital., J Clin Gastroenterol, 46, 567, 10.1097/MCG.0b013e31823d3305

Aceves, 2009, A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation., Ann Allergy Asthma Immunol, 103, 401, 10.1016/S1081-1206(10)60359-6

Mukkada, 2010, Feeding dysfunction in children with eosinophilic gastrointestinal diseases., Pediatrics, 126, e672, 10.1542/peds.2009-2227

Mackenzie, 2008, Clinical trial: eosinophilic esophagitis in patients presenting with dysphagia: a prospective analysis., Aliment Pharmacol Ther, 28, 1140, 10.1111/j.1365-2036.2008.03795.x

Desai, 2005, Association of eosinophilic inflammation with esophageal food impaction in adults., Gastrointest Endosc, 61, 795, 10.1016/S0016-5107(05)00313-5

Fass, 2008, Refractory GERD: what is it?, Curr Gastroenterol Rep, 10, 252, 10.1007/s11894-008-0052-5

Gupta, 1997, Vertical lines in distal esophageal mucosa (VLEM): a true endoscopic manifestation of esophagitis in children?, Gastrointest Endosc, 45, 485, 10.1016/S0016-5107(97)70178-0

Straumann, 2003, Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis?, Gastrointest Endosc, 57, 407, 10.1067/mge.2003.123

Straumann, 2004, Eosinophilic esophagitis: red on microscopy, white on endoscopy., Digestion, 70, 109, 10.1159/000080934

Peery, 2011, Variable reliability of endoscopic findings with white-light and narrow-band imaging for patients with suspected eosinophilic esophagitis., Clin Gastroenterol Hepatol, 9, 475, 10.1016/j.cgh.2011.02.026

Prasad, 2009, Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota., Clin Gastroenterol Hepatol, 7, 1055, 10.1016/j.cgh.2009.06.023

Lucendo, 2007, Endoscopic, bioptic, and manometric findings in eosinophilic esophagitis before and after steroid therapy: a case series., Endoscopy, 39, 765, 10.1055/s-2007-966738

Muller, 2007, Analysis of symptoms and endoscopic findings in 117 patients with histological diagnoses of eosinophilic esophagitis., Endoscopy, 39, 339, 10.1055/s-2007-966216

Hirano, 2013, Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system., Gut, 62, 489, 10.1136/gutjnl-2011-301817

Kwiatek, 2011, Mechanical properties of the esophagus in eosinophilic esophagitis., Gastroenterology, 140, 82, 10.1053/j.gastro.2010.09.037

Saffari, 2012, Patchy eosinophil distributions in an esophagectomy specimen from a patient with eosinophilic esophagitis: implications for endoscopic biopsy., J Allergy Clin Immunol, 130, 798, 10.1016/j.jaci.2012.03.009

Yantiss, 2009, Optimal approach to obtaining mucosal biopsies for assessment of inflammatory disorders of the gastrointestinal tract., Am J Gastroenterol, 104, 774

Kagalwalla, 2006, Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis., Clin Gastroenterol Hepatol, 4, 1097, 10.1016/j.cgh.2006.05.026

Mishra, 2001, An etiological role for aeroallergens and eosinophils in experimental esophagitis., J Clin Invest, 107, 83, 10.1172/JCI10224

Gonsalves, 2006, Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis., Gastrointest Endosc, 64, 313, 10.1016/j.gie.2006.04.037

Shah, 2009, Histopathologic variability in children with eosinophilic esophagitis., Am J Gastroenterol, 104, 716

Liacouras, 2005, Eosinophilic esophagitis: a 10-year experience in 381 children., Clin Gastroenterol Hepatol, 3, 1198, 10.1016/S1542-3565(05)00885-2

Dellon, 2007, Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review., Am J Gastroenterol, 102, 2300, 10.1111/j.1572-0241.2007.01396.x

Kephart, 2010, Marked deposition of eosinophil-derived neurotoxin in adult patients with eosinophilic esophagitis., Am J Gastroenterol, 105, 298, 10.1038/ajg.2009.584

Mueller, 2008, Comparison of histological parameters for the diagnosis of eosinophilic oesophagitis versus gastro-oesophageal reflux disease on oesophageal biopsy material., Histopathology, 53, 676, 10.1111/j.1365-2559.2008.03187.x

Dellon, 2012, Diagnostic utility of major basic protein, eotaxin-3, and leukotriene enzyme staining in eosinophilic esophagitis., Am J Gastroenterol, 107, 1503, 10.1038/ajg.2012.202

Ravi, 2011, Prevalence of esophageal eosinophils in patients with Barretts esophagus., Am J Gastroenterol, 106, 851, 10.1038/ajg.2011.7

Molina-Infante, 2011, Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults., Clin Gastroenterol Hepatol, 9, 110, 10.1016/j.cgh.2010.09.019

Dranove, 2009, Predictors of response to proton pump inhibitor therapy among children with significant esophageal eosinophilia., J Pediatr, 154, 96, 10.1016/j.jpeds.2008.07.042

Sayej, 2009, Treatment with high-dose proton pump inhibitors helps distinguish eosinophilic esophagitis from noneosinophilic esophagitis., J Pediatr Gastroenterol Nutr, 49, 393, 10.1097/MPG.0b013e31819c4b3e

Dohil, 2012, Transient PPI responsive esophageal eosinophilia may be a clinical sub-phenotype of pediatric eosinophilic esophagitis., Dig Dis Sci, 57, 1413, 10.1007/s10620-011-1991-5

Tobey, 1996, Dilated intercellular spaces: a morphological feature of acid reflux-damaged human esophageal epithelium., Gastroenterology, 111, 1200, 10.1053/gast.1996.v111.pm8898633

Bytzer, 2012, Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease., Clin Gastroenterol Hepatol, 10, 1360, 10.1016/j.cgh.2012.06.030

Francis, 2012, Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis., Aliment Pharmacol Ther, 35, 300, 10.1111/j.1365-2036.2011.04922.x

Kagalwalla, 2011, Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet., J Pediatr Gastroenterol Nutr, 53, 145, 10.1097/MPG.0b013e31821cf503

Konikoff, 2006, A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis., Gastroenterology, 131, 1381, 10.1053/j.gastro.2006.08.033

Lai, 2009, Diagnostic criteria for eosinophilic esophagitis: a 5-year retrospective review in a pediatric population., J Pediatr Gastroenterol Nutr, 49, 63, 10.1097/MPG.0b013e318184c917

Peterson, 2010, Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis., Dig Dis Sci, 55, 1313, 10.1007/s10620-009-0859-4

Dellon, 2009, Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease., Clin Gastroenterol Hepatol, 7, 1305, 10.1016/j.cgh.2009.08.030

Remedios, 2006, Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate., Gastrointest Endosc, 63, 3, 10.1016/j.gie.2005.07.049

Pentiuk, 2009, Dissociation between symptoms and histological severity in pediatric eosinophilic esophagitis., J Pediatr Gastroenterol Nutr, 48, 152, 10.1097/MPG.0b013e31817f0197

Aceves, 2007, Oral viscous budesonide: a potential new therapy for eosinophilic esophagitis in children., Am J Gastroenterol, 102, 2271, 10.1111/j.1572-0241.2007.01379.x

Aceves, 2005, Topical viscous budesonide suspension for treatment of eosinophilic esophagitis., J Allergy Clin Immunol, 116, 705, 10.1016/j.jaci.2005.05.011

Teitelbaum, 2002, Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate., Gastroenterology, 122, 1216, 10.1053/gast.2002.32998

Arora, 2003, Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults., Mayo Clin Proc, 78, 830, 10.4065/78.7.830

Noel, 2004, Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis., Clin Gastroenterol Hepatol, 2, 568, 10.1016/S1542-3565(04)00240-X

Attwood, 2003, Eosinophilic oesophagitis: a novel treatment using Montelukast., Gut, 52, 181, 10.1136/gut.52.2.181

Lucendo, 2011, Montelukast was inefficient in maintaining steroid-induced remission in adult eosinophilic esophagitis., Dig Dis Sci, 56, 3551, 10.1007/s10620-011-1775-y

Abonia, 2010, Involvement of mast cells in eosinophilic esophagitis., J Allergy Clin Immunol, 126, 140, 10.1016/j.jaci.2010.04.009

Dellon, 2011, Tryptase staining of mast cells may differentiate eosinophilic esophagitis from gastroesophageal reflux disease., Am J Gastroenterol, 106, 264, 10.1038/ajg.2010.412

Sridhara, 2012, Increased numbers of eosinophils, rather than only etiology, predict histologic changes in patients with esophageal eosinophilia., Clin Gastroenterol Hepatol, 10, 735, 10.1016/j.cgh.2012.01.008

Netzer, 2007, Corticosteroid-dependent eosinophilic oesophagitis: azathioprine and 6-mercaptopurine can induce and maintain long-term remission., Eur J Gastroenterol Hepatol, 19, 865, 10.1097/MEG.0b013e32825a6ab4

Assaad, 2011, An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis., Gastroenterology, 141, 1593, 10.1053/j.gastro.2011.07.044

Straumann, 2010, Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomised, placebo-controlled, double-blind trial., Gut, 59, 21, 10.1136/gut.2009.178558

Rocha, 2011, Omalizumab in the treatment of eosinophilic esophagitis and food allergy., Eur J Pediatr, 170, 1471, 10.1007/s00431-011-1540-4

Spergel, 2002, The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis., J Allergy Clin Immunol, 109, 363, 10.1067/mai.2002.121458

Markowitz, 2003, Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents., Am J Gastroenterol, 98, 777, 10.1111/j.1572-0241.2003.07390.x

Henderson, 2012, Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis., J Allergy Clin Immunol, 129, 1570, 10.1016/j.jaci.2012.03.023

Simon, 2006, Eosinophilic esophagitis in adults-no clinical relevance of wheat and rye sensitizations., Allergy, 61, 1480, 10.1111/j.1398-9995.2006.01224.x

Kagalwalla, 2007, Cows milk protein-induced eosinophilic esophagitis in a child with gluten-sensitive enteropathy., J Pediatr Gastroenterol Nutr, 44, 386, 10.1097/01.mpg.0000243430.32087.5c

Lee, 2012, Esophageal diameter is decreased in some patients with eosinophilic esophagitis and might increase with topical corticosteroid therapy., Clin Gastroenterol Hepatol, 10, 481, 10.1016/j.cgh.2011.12.042

Schoepfer, 2010, Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation., Am J Gastroenterol, 105, 1062, 10.1038/ajg.2009.657

Bohm, 2010, Esophageal dilation: simple and effective treatment for adults with eosinophilic esophagitis and esophageal rings and narrowing., Dis Esophagus, 23, 377

Bohm, 2011, Review article: oesophageal dilation in adults with eosinophilic oesophagitis., Aliment Pharmacol Ther, 33, 748, 10.1111/j.1365-2036.2011.04593.x

Cohen, 2007, An audit of endoscopic complications in adult eosinophilic esophagitis., Clin Gastroenterol Hepatol, 5, 1149, 10.1016/j.cgh.2007.05.017

Kaplan, 2003, Endoscopy in eosinophilic esophagitis: feline esophagus and perforation risk., Clin Gastroenterol Hepatol, 1, 433, 10.1016/S1542-3565(03)00222-2

Jacobs, 2010, A systematic review of the risk of perforation during esophageal dilation for patients with eosinophilic esophagitis., Dig Dis Sci, 55, 1512, 10.1007/s10620-010-1165-x

Assaad, 2007, Pediatric patients with eosinophilic esophagitis: an 8-year follow-up., J Allergy Clin Immunol, 119, 731, 10.1016/j.jaci.2006.10.044

DeBrosse, 2011, Long-term outcomes in pediatric-onset esophageal eosinophilia., J Allergy Clin Immunol, 128, 132, 10.1016/j.jaci.2011.05.006

Menard-Katcher, 2013, The natural history of eosinophilic oesophagitis in the transition from childhood to adulthood., Aliment Pharmacol Ther, 37, 114, 10.1111/apt.12119

Straumann, 2003, Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years., Gastroenterology, 125, 1660, 10.1053/j.gastro.2003.09.024

Straumann, 2011, The natural history and complications of eosinophilic esophagitis., Thorac Surg Clin, 21, 575, 10.1016/j.thorsurg.2011.09.004

Aceves, 2007, Esophageal remodeling in pediatric eosinophilic esophagitis., J Allergy Clin Immunol, 119, 206, 10.1016/j.jaci.2006.10.016

Chehade, 2007, Esophageal subepithelial fibrosis in children with eosinophilic esophagitis., J Pediatr Gastroenterol Nutr, 45, 319, 10.1097/MPG.0b013e31806ab384

Liacouras, 1998, Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids., J Pediatr Gastroenterol Nutr, 26, 380, 10.1097/00005176-199804000-00004

Helou, 2008, 3-Yr-follow-up of topical corticosteroid treatment for eosinophilic esophagitis in adults., Am J Gastroenterol, 103, 2194, 10.1111/j.1572-0241.2008.01989.x

Spergel, 2005, Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests., Ann Allergy Asthma Immunol, 95, 336, 10.1016/S1081-1206(10)61151-9