Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
Jorge Amil Dias, Salvatore Oliva, Αλεξάνδρα Παπαδοπούλου, Mike Thomson, Carolina Gutiérrez‐Junquera, Nicolas Kalach, Rok Orel, Marcus Karl‐Heinz Auth, Danielle Nijenhuis‐Hendriks, Caterina Strisciuglio, Olivia Bauraind, Sonny K. F. Chong, Gloria Domínguez Ortega, Sonia Fernández‐Fernández, Mark Furman, Roger García-Puig, Frédèric Gottrand, Matjaž Homan, Koen Huysentruyt, Aco Kostovski, Sebastian Otte, Francesca Rea, Elefthería Roma, Claudio Romano, Christos Tzivinikos, Vaidotas Urbonas, Saskia Vande Velde, Tsili Zangen, Noam Zevit
Abstract
INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary. METHODS: A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations. RESULTS: A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline. CONCLUSION: Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE.