Guidelines Summary

In May 2020, the American Gastroenterological Association (AGA) Institute and the Joint Task Force on Practice Parameters (JTF) from the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology issued clinical practice recommendations on the management of eosinophilic esophagitis.^[65]

In patients with symptomatic esophageal eosinophilia, the use of proton pump inhibition is suggested over no treatment.

In patients with eosinophilic esophagitis (EoE), topical glucocorticosteroid use is recommended over no treatment.

In patients with EoE, topical glucocorticosteroid use is suggested over employment of oral glucocorticosteroids.

In patients with EoE, use of an elemental diet is suggested over no treatment.

In patients with EoE, use of an empiric, six-food elimination diet is suggested over no treatment.

In patients with EoE, an allergy testing–based elimination diet is suggested over no treatment. However, because the accuracy of currently available allergy-based testing for the identification of specific EoE food triggers is potentially limited, patients may desire alternative medical or dietary treatments over an exclusively testing-based elimination diet.

In patients with EoE in remission after short-term use of topical glucocorticosteroids, continuation of these topical agents is suggested over discontinuation of therapy. However, patients who strongly wish to avoid long-term topical steroid use and its possible adverse effects and/or who give lower importance to the prevention of potential long-term, undesirable outcomes of EoE (ie, recurrent dysphagia, food impaction, esophageal stricture) could reasonably prefer treatment cessation following initial remission, provided that clinical follow-up is maintained.

In adult patients in whom dysphagia has resulted from a stricture associated with EoE, endoscopic dilation is suggested over no dilation.

The use of anti–immunoglobulin E (anti-IgE) treatment for EoE is suggested against.

For more information, please go to Eosinophilic Esophagitis.

For more Clinical Practice Guidelines, please go to Guidelines.

Medication

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Media Gallery

Esophagitis. Location of fungal and viral infections in ulcers.
Peptic esophagitis. A rapid urease test (RUT) was performed on the esophageal biopsy sample. The result was positive for Helicobacter pylori.
Corrosive esophagitis. This is a vinegar-induced esophageal burn. The patient had a fish bone in her throat. She ingested vinegar in an attempt to dissolve the fish bone but to no avail; this led to corrosive esophagitis.
Infectious esophagitis. Candida esophagitis. Double-contrast esophagram shows linear plaquelike lesions in the esophagus, with normal intervening mucosa.
Infectious esophagitis. Two examples of advanced Candida esophagitis demonstrate a shaggy esophagus. In both images, the double-contrast esophagram shows a grossly irregular esophageal contour due to innumerable plaques and pseudomembranes, with the trapping of barium between lesions. Patients with this fulminant form of esophageal candidiasis are almost always found to have acquired immunodeficiency syndrome (AIDS).
Infectious esophagitis. Candida esophagitis with a foamy esophagus. This patient has a dilated esophagus with beaklike narrowing (arrow) at the gastroesophageal junction as a result of long-standing achalasia. Innumerable tiny bubbles are layering out in the barium column due to infection by the yeast form of candidiasis.
Infectious esophagitis. Herpes esophagitis. Double-contrast esophagram shows small, discrete ulcers (arrows) in the mid esophagus on a normal background mucosa. Note the radiolucent mounds of edema surrounding the ulcers. In the appropriate clinical setting, this appearance is highly suggestive of herpes esophagitis, since ulceration in candidiasis almost always occurs on a background of diffuse plaque formation.
Infectious esophagitis. Cytomegalovirus esophagitis in a patient with acquired immunodeficiency syndrome (AIDS). Double-contrast esophagram shows a large, flat ulcer in profile (large arrows) in the mid esophagus with a cluster of small satellite ulcers (small arrows). Because HIV esophagitis may produce identical radiographic findings, endoscopy is required to confirm the presence of cytomegalovirus before patients are treated.
Infectious esophagitis. Two examples of giant human immunodeficiency virus (HIV) esophageal ulcers (arrows) in patients with acquired immunodeficiency syndrome (AIDS). In A, the ulcer is seen in profile, whereas in B, the ulcer is seen en face. Endoscopy is required to exclude cytomegalovirus as the cause of this finding before treating patients.

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Author

Deepika Devuni, MD Assistant Professor of Gastroenterology, University of Massachusetts Medical School

Deepika Devuni, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Association of Physicians of Indian Origin, American College of Gastroenterology, American Gastroenterological Association, American Society of Transplantation

Disclosure: SIte PI for: Sequana Medical .

Coauthor(s)

John W Birk, MD, FACG Professor of Medicine, University of Connecticut School of Medicine; Chief, Division of Gastroenterology, Key Clinic Faculty, Gastroenterology and Hepatology Fellowship Program, University of Connecticut Health Center

John W Birk, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Sajid Ansari, MD Consulting Staff, Department of Gastroenterology, St Anthony's Medical Center

Sajid Ansari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Chin Hung Chung, MBBS, FRCS(Glasg), FHKAM(Surgery) Chief of Service, Department of Accident and Emergency, North District Hospital, Hong Kong

Chin Hung Chung, MBBS, FRCS(Glasg), FHKAM(Surgery) is a member of the following medical societies: American College of Surgeons and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

James Li, MD Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chun-hing Ludwig Tsoi MB, ChB, MPH, MRCP, FRCS(Edin), Senior Medical Officer, Accident and Emergency Department, Tseng Kwan O Hospital, Hong Kong; Chairman, Committee on Training, Hong Kong St John Ambulance

Chun-hing Ludwig Tsoi is a member of the following medical societies: Royal College of Physicians of the United Kingdom and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.