Eosinophilic Esophagitis Clinical Practice Guidelines (BSG/BSPGHAN, 2022)

British Society of Gastroenterology, British Society of Paediatric Gastroenterology, Hepatology and Nutrition

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

September 29, 2022

Clinical practice guidelines on the diagnosis and management of eosinophilic esophagitis from the British Society of Gastroenterology (BSG) and the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) were published in August 2022 in Gut.[1]

Biopsy is recommended for all adult patients who have dysphagia or food bolus obstruction and a normal-appearing esophagus on endoscopy, as well as those who have endoscopic findings specifically associated with eosinophilic esophagitis, such as furrows, rings, white plaques, mucosal edema, fragile mucosa, a narrow-caliber esophagus, and strictures.

These endoscopic findings are less reliable indicators in children; thus, biopsy is recommended for all pediatric patients who are undergoing endoscopy because of upper gastrointestinal symptoms.

At least 3 weeks before endoscopy and biopsy, withdrawal of proton pump inhibitor (PPI) therapy is recommended to improve the accuracy of a diagnosis of eosinophilic esophagitis.

A minimum of six biopsies obtained from different anatomic sites within the esophagus is recommended for the diagnosis and monitoring of eosinophilic esophagitis. The cut-off eosinophil density for diagnosis should be 15 or more eosinophils per 0.3 mm2 in any biopsy specimen.

In patients with treated eosinophilic esophagitis, it is suggested that remission be defined as a maximum eosinophil count of less than 15 eosinophils per 0.3 mm2 in any biopsy specimen.

If dietary therapy is considered for eosinophilic esophagitis, the supervision of an experienced dietitian is recommended. Treatment should start with a two-food elimination diet and progress to a more restrictive diet if needed. Endoscopic and histologic evaluation is recommended between 8 and 12 weeks later.

Elemental diets that use amino acid-based feeds should be reserved for select patients whose eosinophilic esophagitis is refractory to other treatments.

PPI therapy is recommended for patients with eosinophilic esophagitis, because it is effective in inducing histologic and clinical remission. Before the histologic response is assessed, patients should receive PPI therapy two times per day for at least 8-12 weeks.

Topical corticosteroid maintenance therapy is recommended for patients with eosinophilic esophagitis to help prevent the recurrence of food bolus obstruction.

If symptoms of eosinophilic esophagitis recur during therapy, repeated endoscopy and biopsy are recommended both for histologic evaluation and to rule out complications of the disease or treatment.

For more information, please go to Eosinophilic Esophagitis.


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