title: Eosinophilic esophagitis: updated consensus recommendations for children and adults.
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.
authors.affiliation: Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. liacouras@email.chop.edu
authors.forename: Chris A
authors.initials: CA
authors.lastname: Liacouras
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Furuta
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
authors.forename: Dan
authors.initials: D
authors.lastname: Atkins
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Attwood
authors.forename: Peter A
authors.initials: PA
authors.lastname: Bonis
authors.forename: A Wesley
authors.initials: AW
authors.lastname: Burks
authors.forename: Mirna
authors.initials: M
authors.lastname: Chehade
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Collins
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.forename: Ranjan
authors.initials: R
authors.lastname: Dohil
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: Nirmala
authors.initials: N
authors.lastname: Gonsalves
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Gupta
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Markowitz
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Noel
authors.forename: Robert D
authors.initials: RD
authors.lastname: Odze
authors.forename: Philip E
authors.initials: PE
authors.lastname: Putnam
authors.forename: Joel E
authors.initials: JE
authors.lastname: Richter
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Romero
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ruchelli
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Sampson
authors.forename: Alain
authors.initials: A
authors.lastname: Schoepfer
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Scott H
authors.initials: SH
authors.lastname: Sicherer
authors.forename: Stuart
authors.initials: S
authors.lastname: Spechler
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
authors.forename: Alex
authors.initials: A
authors.lastname: Straumann
authors.forename: Barry K
authors.initials: BK
authors.lastname: Wershil
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rothenberg
authors.forename: Seema S
authors.initials: SS
authors.lastname: Aceves
mesh_terms: D000328:Adult; D002648:Child; D003245:Consensus Statements as Topic; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy*; D017408:Guidelines as Topic; D006801:Humans