What are the AGA treatment guidelines for eosinophilic esophagitis?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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In May 2020, the American Gastroenterological Association (AGA) Institute and the Joint Task Force on Practice Parameters (JTF) from the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology issued clinical practice recommendations on the management of eosinophilic esophagitis. [65]

In patients with symptomatic esophageal eosinophilia, the use of proton pump inhibition is suggested over no treatment.

In patients with eosinophilic esophagitis (EoE), topical glucocorticosteroid use is recommended over no treatment.

In patients with EoE, topical glucocorticosteroid use is suggested over employment of oral glucocorticosteroids.

In patients with EoE, use of an elemental diet is suggested over no treatment.

In patients with EoE, use of an empiric, six-food elimination diet is suggested over no treatment.

In patients with EoE, an allergy testing–based elimination diet is suggested over no treatment. However, because the accuracy of currently available allergy-based testing for the identification of specific EoE food triggers is potentially limited, patients may desire alternative medical or dietary treatments over an exclusively testing-based elimination diet.

In patients with EoE in remission after short-term use of topical glucocorticosteroids, continuation of these topical agents is suggested over discontinuation of therapy. However, patients who strongly wish to avoid long-term topical steroid use and its possible adverse effects and/or who give lower importance to the prevention of potential long-term, undesirable outcomes of EoE (ie, recurrent dysphagia, food impaction, esophageal stricture) could reasonably prefer treatment cessation following initial remission, provided that clinical follow-up is maintained.

In adult patients in whom dysphagia has resulted from a stricture associated with EoE, endoscopic dilation is suggested over no dilation.

The use of anti–immunoglobulin E (anti-IgE) treatment for EoE is suggested against.

For more information, please go to Eosinophilic Esophagitis.

For more Clinical Practice Guidelines, please go to Guidelines.

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