Eosinophilic esophagitis: Updated consensus recommendations for children and adults - 11/08/11
, Glenn T. Furuta, MD, Ikuo Hirano, MD, Dan Atkins, MD, Stephen E. Attwood, MD, FRCS, FRCSI, MCh, Peter A. Bonis, MD, A. Wesley Burks, MD, Mirna Chehade, MD, Margaret H. Collins, MD, Evan S. Dellon, MD, MPH, Ranjan Dohil, MD, Gary W. Falk, MD, MS, Nirmala Gonsalves, MD, Sandeep K. Gupta, MD, David A. Katzka, MD, Alfredo J. Lucendo, MD, PhD, Jonathan E. Markowitz, MD, MSCE, Richard J. Noel, MD, Robert D. Odze, MD, FRCP, Philip E. Putnam, MD, FAAP, Joel E. Richter, MD, FACP, MACG, Yvonne Romero, MD, Eduardo Ruchelli, MD, Hugh A. Sampson, MD, Alain Schoepfer, MD, Nicholas J. Shaheen, MD, MPH, Scott H. Sicherer, MD, Stuart Spechler, MD, Jonathan M. Spergel, MD, PhD, Alex Straumann, MD, Barry K. Wershil, MD, Marc E. Rothenberg, MD, PhD 
, Seema S. Aceves, MD, PhD Reprint requests: Chris A. Liacouras, MD, Exton Specialty Center, The Children’s Hospital of Philadelphia, 481 John Young Way, Exton, PA 19341.Abstract |
Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.
Le texte complet de cet article est disponible en PDF.Key words : Eosinophils, eosinophilic, esophagitis, esophageal, food allergy
Abbreviations used : APT, CR, EoE, GERD, hpf, PPI, SPT, TSLP
Plan
| Series editors: Donald Y. M. Leung, MD, PhD, and Dennis K. Ledford, MD |
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| Complete information for the authors, including affiliations and study responsibilities, is shown in Appendix E1 in this article’s Online Repository at www.jacionline.org. |
Vol 128 - N° 1
P. 3 - juillet 2011 Retour au numéro
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- News Beyond Our Pages
- Marc E. Rothenberg, Jean Bousquet
- Eosinophilic esophagitis: Updated consensus recommendations for children and adults
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