Article

Eosinophilic esophagitis: Updated consensus recommendations for children and adults

Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.25). 04/2011; 128(1):3-20.e6; quiz 21-2. DOI: 10.1016/j.jaci.2011.02.040
Source: PubMed

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.

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    • "These agents should provide stable contrast despite transient interference from bowel gas, enabling molecular imaging of normal and abnormal structures throughout the gastrointestinal (GI) tract (Mittal et al. 2005; Schwartz et al. 2001). Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus caused by the infiltration and activation of eosinophils in the esophageal mucosa (Furuta et al. 2007; Liacouras et al. 2011; Straumann et al. 2003). Current diagnosis requires collection of multiple biopsies throughout the esophagus, which are evaluated for eosinophilic invasion (Dellon et al. 2013). "
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    • "The presence of more than 15 eosinophils per high power field (HPF) is the gold standard for diagnosis [5]. EoE has been shown to be a T-helper-2 lymphocyte-driven disorder with upregulation of interleukins (IL) 4, 5 and 13 [5]. The number of mucosal mast-cells is also increased and migration of eosinophils to the oesophagus is controlled by three critical effector molecules: IL- 5, IL-13, eotaxin-3 [6]. "
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    • "Ce traitement, bien qu'efficace et avec un taux de complications faible, devrait rester un traitement de deuxième ligne, en cas d'échec du traitement médicamenteux [14]. D'autres traitements comme les inhibiteurs des leucotriènes (montélukast), les inhibiteurs de l'interleukine 5 (mépolizumab ) et les immunosuppresseurs (azathioprine, 6-mercapto- purine) sont actuellement en cours d'étude et ne sont pas recommandés [8]. "
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