Recommendations are presented for the management of eosinophilic esophagitis (EoE) in clinical practice guidelines published in the May issue of Gastroenterology.
Ikuo Hirano, M.D., from Northwestern University Feinberg School of Medicine in Chicago, and colleagues developed recommendations for clinical management of EoE for pediatric and adult allergists and gastroenterologists; the recommendations are applicable to short-term treatment of EoE.
According to the recommendations, proton pump inhibition therapy is suggested over no treatment for patients with symptomatic esophageal eosinophilia. In patients with EoE, topical glucocorticosteroids are recommended over no treatment; topical glucocorticosteroids are suggested rather than oral glucocorticosteroids. An elemental diet or an empiric six-food elimination diet is suggested over no treatment for patients with EoE; these treatment options will likely be declined by patients who put a higher value on avoiding the challenges associated with adherence to an elemental diet or a diet involving elimination of multiple common food staples. An allergy testing-based elimination diet is suggested over no treatment for patients with EoE. For patients in remission after short-term topical glucocorticosteroid use, continuation of topical glucocorticosteroids is suggested over discontinuation of treatment. Anti-interleukin-5 (IL-5), anti-IL-13, or anti IL-4 receptor-α therapy is recommended only in the context of a clinical trial. The researchers note that new targeted biologic therapies for EoE are currently being evaluated and more research is necessary before a recommendation can be provided on their use.
"As the field moves forward, a deeper understanding of the natural history of EoE in both children and adults is needed to inform clinical decisions regarding the optimal use of disease monitoring and long-term, maintenance therapy," Hirano said in a statement.