title: Management guidelines of eosinophilic esophagitis in childhood.
abstract: OBJECTIVE
  Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. With few exceptions, 15 eosinophils per high-power field (peak value) in ≥1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor-responsive esophageal eosinophilia. This position paper aims at providing practical guidelines for the management of children and adolescents with EoE.
  
  
  METHODS
  Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of an evidence base, recommendations reflect the expert opinion of the authors. Final consensus was obtained during 3 face-to-face meetings of the Gastroenterology Committee and 1 teleconference.
  
  
  RESULTS
  The cornerstone of treatment is an elimination diet (targeted or empiric elimination diet, amino acid-based formula) and/or swallowed, topical corticosteroids. Systemic corticosteroids are reserved for severe symptoms requiring rapid relief or where other treatments have failed. Esophageal dilatation is an option in children with EoE who have esophageal stenosis unresponsive to drug therapy. Maintenance treatment may be required in case of frequent relapse, although an optimal regimen still needs to be determined.
  
  
  CONCLUSIONS
  EoE is a chronic, relapsing inflammatory disease with largely unquantified long-term consequences. Investigations and treatment are tailored to the individual and must not create more morbidity for the patient and family than the disease itself. Better maintenance treatment as well as biomarkers for assessing treatment response and predicting long-term complications is urgently needed.
authors.affiliation: *Division of Gastroenterology & Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sophia, Athens, Greece †Dr. von Haunersches Kinderspital, Ludwig-Maximilians-University, Munich, Germany ‡Department of Pediatric Gastroenterology, Addenbrookes Hospital, Cambridge, UK §Department of Pediatrics, Hospital S. João, Porto, Portugal ||Department of Allergy and Immunology, Department of Gastroenterology, University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia ¶Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK #Queen Mary's Hospital for Children, Epsom & St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK **Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Jeanne de Flandre University Hospital, University of Lille, Lille, France ††Hans Christian Andersen Children's Hospital, OUH, Odense, Denmark ‡‡Pediatric Gastroenterology & Nutrition Unit, Department of Sciences for Woman and Child Health, University of Florence, Meyer Children's Hospital, Florence, Italy §§Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands ||||Université Paris Descartes, Sorbonne Cité, Paris, and APHP, Hôpital Necker Enfants Malades, Pediatric Gastroenterology, Paris, France ¶¶Pediatric Center, Clinique des Grangettes, Geneva and Centre Médical Universitaire, Geneva, Switzerland ##Department of Pediatrics, University of Naples "Federico II," Naples, Italy ***Pediatric Gastroenterology Unit, Division of Pediatrics, Hadassah University Hospital, Jerusalem, Israel †††Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Papadopoulou
authors.forename: S
authors.initials: S
authors.lastname: Koletzko
authors.forename: R
authors.initials: R
authors.lastname: Heuschkel
authors.forename: J A
authors.initials: JA
authors.lastname: Dias
authors.forename: K J
authors.initials: KJ
authors.lastname: Allen
authors.forename: S H
authors.initials: SH
authors.lastname: Murch
authors.forename: S
authors.initials: S
authors.lastname: Chong
authors.forename: F
authors.initials: F
authors.lastname: Gottrand
authors.forename: S
authors.initials: S
authors.lastname: Husby
authors.forename: P
authors.initials: P
authors.lastname: Lionetti
authors.forename: M L
authors.initials: ML
authors.lastname: Mearin
authors.forename: F M
authors.initials: FM
authors.lastname: Ruemmele
authors.forename: M G
authors.initials: MG
authors.lastname: Schäppi
authors.forename: A
authors.initials: A
authors.lastname: Staiano
authors.forename: M
authors.initials: M
authors.lastname: Wilschanski
authors.forename: Y
authors.initials: Y
authors.lastname: Vandenplas
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D032921:Consensus; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D004804:Eosinophils; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D012008:Recurrence
chemical_list: D000305:Adrenal Cortex Hormones