Practice Guidelines

Eosinophilic Esophagitis: Management Guidelines from the AGA and JTF

 

Am Fam Physician. 2021 May 1;103(9):573-574.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Food elimination based on allergy testing resolves esophageal inflammation in one-half of patients.

• Medication options for eosinophilic esophagitis include topical steroids delivered via an asthma inhaler and then swallowed and proton pump inhibitors.

• Dysphagia with eosinophilic esophagitis is often secondary to esophageal strictures, which can be treated with endoscopic dilation.

From the AFP Editors

Eosinophilic esophagitis is an inflammatory condition triggered by food antigens in sensitive patients. Initially characterized in the early 1990s, eosinophilic esophagitis is now recognized as a major cause of dysphagia. The evidence base of eosinophilic esophagitis is limited to short-term studies, and symptoms and endoscopic features comprising the diagnosis vary in the literature. Affected patients often have atopic diseases including asthma, allergic rhinitis, and eczema. Eosinophilic esophagitis is definitively diagnosed by eosinophilia visible in esophageal biopsies of symptomatic patients without other reasons for eosinophilia. The American Gastroenterological Association (AGA) and the Joint Task Force on Allergy-Immunology Practice Parameters (JTF) published guidelines for treatment of eosinophilic esophagitis.

Endoscopic Monitoring

Because eosinophilic esophagitis is diagnosed by biopsy, studies often define successful treatment as resolution of inflammation by reducing eosinophils to below 15 per high-power field. Symptom relief may not correspond to changes in biopsy results, and there is debate about whether endoscopy should be repeated or if treatment should be guided by symptoms. Long-term studies are needed to evaluate whether improvement in biopsy results affects patient outcomes.

Dietary Changes

Dietary changes can be effective in resolving inflammation in eosinophilic esophagitis, although studies are limited by lack of control groups and short durations.

An elemental diet, consisting of amino acid-based formulas, resolves

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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