Evidenced Based Approach to the Diagnosis and Management of Esophageal Eosinophilia and Eosinophilic Esophagitis (EoE)

Evan S. Dellon, MD, MPH1,6, Nirmala Gonsalves, MD2,6, Ikuo Hirano, MD, FACG2,6, Glenn T. Furuta, MD3, Chris A. Liacouras, MD4 and David A. Katzka, MD, FACG5

1Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
2Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
3University of Colorado School of Medicine, Children’s Hospital Colorado, National Jewish Health, Denver, Colorado, USA
4Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
6Co-first authors.

Am J Gastroenterol 2013; 108:679–692; doi:10.1038/ajg.2013.71; published online 9 April 2013
Received 27 June 2012; Accepted 19 February 2013
Advance online publication 9 April 2013

Correspondence: Ikuo Hirano, MD, Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, 676 North Saint Clair, Suite 1400, Chicago, Illinois 60611, USA. E-mail: i-hirano@northwestern.edu

Abstract

Esophageal eosinophilia and eosinophilic esophagitis (EoE) are increasingly recognized and prevalent conditions, which now represent common clinical problems encountered by gastroenterologists, pathologists, and allergists. The study of EoE has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Although there are limited data supporting management decisions, clinical parameters are needed to guide the care of patients with eosinophilic-esophageal disorders. In this evidence-based review, recommendations developed by adult and pediatric gastroenterologists are provided for the evaluation and management of these patients. New terminology is emphasized, particularly the concepts of esophageal eosinophilia and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) as entities distinct from EoE.

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