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Management guidelines of eosinophilic esophagitis in childhood
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Papadopoulou, A., Koletzko, S., Heuschkel, R., Dias, J. A., Allen, K. J., Murch, Simon, Chong, S., Gottrand, F., Husby, S., Lionetti, P., Mearin, M. L., Ruemmele, F. M., Schappi, M. G., Staiano, A., Wilschanski, M. and Vandenplas, Y. (2014) Management guidelines of eosinophilic esophagitis in childhood. Journal of Pediatric Gastroenterology and Nutrition, Volume 58 (Number 1). pp. 107-118. doi:10.1097/MPG.0b013e3182a80be1 ISSN 0277-2116.
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Official URL: http://dx.doi.org/10.1097/MPG.0b013e3182a80be1
Abstract
Objectives: 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.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Journal of Pediatric Gastroenterology and Nutrition | ||||
| Publisher: | Lippincott Williams & Wilkins | ||||
| ISSN: | 0277-2116 | ||||
| Official Date: | 2014 | ||||
| Dates: |
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| Volume: | Volume 58 | ||||
| Number: | Number 1 | ||||
| Page Range: | pp. 107-118 | ||||
| DOI: | 10.1097/MPG.0b013e3182a80be1 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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