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January 2025 – The American College of Gastroenterology (ACG) has published updated clinical guidelines for the diagnosis and management of eosinophilic esophagitis (EoE) in the January issue of the American Journal of Gastroenterology. These guidelines provide comprehensive recommendations for healthcare professionals on how to approach this increasingly recognized condition.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus that can lead to symptoms such as dysphagia, food impaction, and heartburn. The new clinical guideline, developed by a team led by Dr. Evan S. Dellon from the University of North Carolina School of Medicine, provides evidence-based recommendations across the domains of diagnosis, treatment, and monitoring, with specific guidance on pediatric cases.
Key Recommendations:
1. Diagnosis:
EoE should be diagnosed when symptoms of esophageal dysfunction are present, along with the detection of at least 15 eosinophils per high-power field in esophageal biopsies. A systematic endoscopic scoring system should be utilized to assess the endoscopic features of the disease at each endoscopy. At least six biopsies from two different levels of the esophagus should be collected to evaluate histologic features consistent with EoE.
2. Treatment:
- Proton Pump Inhibitors (PPIs): The use of PPIs is recommended as a first-line treatment for EoE.
- Topical Steroids: Swallowed topical steroids, such as fluticasone propionate or budesonide, are recommended for managing EoE.
- Food Elimination Diet: An empiric food elimination diet is suggested, although currently available allergy testing to guide food elimination is not advised.
- Dupilumab: For patients aged 12 and older, Dupilumab is recommended for those not responding to PPI therapy. However, the use of Omalizumab is not suggested for EoE treatment.
3. Pediatric Considerations:
The guidelines also address pediatric-specific concerns, recommending Dupilumab for children who do not respond to PPI therapy, marking a significant step forward in personalized care for younger patients.
4. Monitoring & Endoscopic Dilation:
Endoscopic dilation is recommended as an adjunct to medical therapy for patients with esophageal strictures causing dysphagia.
The guideline emphasizes that cost and insurance coverage should be considered on an individual basis for all treatments, as there is limited data on the cost-effectiveness of the available therapies.
Acknowledgments and Disclosures:
Several authors of the guideline disclosed financial ties to the pharmaceutical industry, underscoring the importance of considering potential conflicts of interest in clinical decision-making.
For further reading and full details on the recommendations, refer to the study: ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis in the American Journal of Gastroenterology.
Disclaimer: The content presented in this article is intended for informational purposes only and does not replace professional medical advice. Patients should consult their healthcare providers for specific diagnosis and treatment options tailored to their individual needs.
Source: Evan S. Dellon et al, ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis, American Journal of Gastroenterology (2025). DOI: 10.14309/ajg.0000000000003194
