Eosinophilic esophagitis: Updated consensus recommendations for children and adults

Chris A. Liacouras, Glenn T. Furuta, Ikuo Hirano, Dan Atkins, Stephen E. Attwood, Peter A. Bonis, A. Wesley Burks, Mirna Chehade, Margaret H. Collins, Evan S. Dellon, Ranjan Dohil, Gary W. Falk, Nirmala Gonsalves, Sandeep Gupta, David A. Katzka, Alfredo J. Lucendo, Jonathan E. Markowitz, Richard J. Noel, Robert D. Odze, Philip E. PutnamJoel E. Richter, Yvonne Romero, Eduardo Ruchelli, Hugh A. Sampson, Alain Schoepfer, Nicholas J. Shaheen, Scott H. Sicherer, Stuart Spechler, Jonathan M. Spergel, Alex Straumann, Barry K. Wershil, Marc E. Rothenberg, Seema S. Aceves

Research output: Contribution to journalArticle

1253 Citations (Scopus)

Abstract

Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.

Original languageEnglish (US)
Pages (from-to)3-20
Number of pages18
JournalJournal of Allergy and Clinical Immunology
Volume128
Issue number1
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Eosinophilic Esophagitis
Hypersensitivity
Guidelines
Physicians
Antigens
Proton Pump Inhibitors
Disease Susceptibility
Genetic Testing
Gastroenterology
Therapeutics
Allergy and Immunology
Eosinophils
Esophagus
Publications
Dilatation
Adrenal Cortex Hormones
Biomarkers
Databases
Pediatrics
Pathology

Keywords

  • eosinophilic
  • Eosinophils
  • esophageal
  • esophagitis
  • food allergy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Liacouras, C. A., Furuta, G. T., Hirano, I., Atkins, D., Attwood, S. E., Bonis, P. A., ... Aceves, S. S. (2011). Eosinophilic esophagitis: Updated consensus recommendations for children and adults. Journal of Allergy and Clinical Immunology, 128(1), 3-20. https://doi.org/10.1016/j.jaci.2011.02.040

Eosinophilic esophagitis : Updated consensus recommendations for children and adults. / Liacouras, Chris A.; Furuta, Glenn T.; Hirano, Ikuo; Atkins, Dan; Attwood, Stephen E.; Bonis, Peter A.; Burks, A. Wesley; Chehade, Mirna; Collins, Margaret H.; Dellon, Evan S.; Dohil, Ranjan; Falk, Gary W.; Gonsalves, Nirmala; Gupta, Sandeep; Katzka, David A.; Lucendo, Alfredo J.; Markowitz, Jonathan E.; Noel, Richard J.; Odze, Robert D.; Putnam, Philip E.; Richter, Joel E.; Romero, Yvonne; Ruchelli, Eduardo; Sampson, Hugh A.; Schoepfer, Alain; Shaheen, Nicholas J.; Sicherer, Scott H.; Spechler, Stuart; Spergel, Jonathan M.; Straumann, Alex; Wershil, Barry K.; Rothenberg, Marc E.; Aceves, Seema S.

In: Journal of Allergy and Clinical Immunology, Vol. 128, No. 1, 07.2011, p. 3-20.

Research output: Contribution to journalArticle

Liacouras, CA, Furuta, GT, Hirano, I, Atkins, D, Attwood, SE, Bonis, PA, Burks, AW, Chehade, M, Collins, MH, Dellon, ES, Dohil, R, Falk, GW, Gonsalves, N, Gupta, S, Katzka, DA, Lucendo, AJ, Markowitz, JE, Noel, RJ, Odze, RD, Putnam, PE, Richter, JE, Romero, Y, Ruchelli, E, Sampson, HA, Schoepfer, A, Shaheen, NJ, Sicherer, SH, Spechler, S, Spergel, JM, Straumann, A, Wershil, BK, Rothenberg, ME & Aceves, SS 2011, 'Eosinophilic esophagitis: Updated consensus recommendations for children and adults', Journal of Allergy and Clinical Immunology, vol. 128, no. 1, pp. 3-20. https://doi.org/10.1016/j.jaci.2011.02.040
Liacouras, Chris A. ; Furuta, Glenn T. ; Hirano, Ikuo ; Atkins, Dan ; Attwood, Stephen E. ; Bonis, Peter A. ; Burks, A. Wesley ; Chehade, Mirna ; Collins, Margaret H. ; Dellon, Evan S. ; Dohil, Ranjan ; Falk, Gary W. ; Gonsalves, Nirmala ; Gupta, Sandeep ; Katzka, David A. ; Lucendo, Alfredo J. ; Markowitz, Jonathan E. ; Noel, Richard J. ; Odze, Robert D. ; Putnam, Philip E. ; Richter, Joel E. ; Romero, Yvonne ; Ruchelli, Eduardo ; Sampson, Hugh A. ; Schoepfer, Alain ; Shaheen, Nicholas J. ; Sicherer, Scott H. ; Spechler, Stuart ; Spergel, Jonathan M. ; Straumann, Alex ; Wershil, Barry K. ; Rothenberg, Marc E. ; Aceves, Seema S. / Eosinophilic esophagitis : Updated consensus recommendations for children and adults. In: Journal of Allergy and Clinical Immunology. 2011 ; Vol. 128, No. 1. pp. 3-20.
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