Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference

Evan S. Dellon; Chris A. Liacouras; Javier Molina-Infante; Glenn T. Furuta; Jonathan M. Spergel; Noam Zevit; Stuart J. Spechler; Stephen E. Attwood; Alex Straumann; Seema S. Aceves; Jeffrey A. Alexander; Dan Atkins; Nicoleta C. Arva; Carine Blanchard; Peter A. Bonis; Wendy M. Book; Kelley E. Capocelli; Mirna Chehade; Edaire Cheng; Margaret H. Collins; Carla M. Davis; Jorge A. Dias; Carlo Di Lorenzo; Ranjan Dohil; Christophe Dupont; Gary W. Falk; Cristina T. Ferreira; Adam Fox; Nirmala P. Gonsalves; Sandeep K. Gupta; David A. Katzka; Yoshikazu Kinoshita; Calies Menard-Katcher; Ellyn Kodroff; David C. Metz; Stephan Miehlke; Amanda B. Muir; Vincent A. Mukkada; Simon Murch; Samuel Nurko; Yoshikazu Ohtsuka; Rok Orel; Alexandra Papadopoulou; Kathryn A. Peterson; Hamish Philpott; Philip E. Putnam; Joel E. Richter; Rachel Rosen; Marc E. Rothenberg; Alain Schoepfer; Melissa M. Scott; Neil Shah; Javed Sheikh; Rhonda F. Souza; Mary J. Strobel; Nicholas J. Talley; Michael F. Vaezi; Yvan Vandenplas; Mario C. Vieira; Marjorie M. Walker; Joshua B. Wechsler; Barry K. Wershil; Ting Wen; Guang Yu Yang; Ikuo Hirano; Albert J. Bredenoord

doi:10.1053/j.gastro.2018.07.009

Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference

Evan S. Dellon, Chris A. Liacouras, Javier Molina-Infante, Glenn T. Furuta, Jonathan M. Spergel, Noam Zevit, Stuart J. Spechler, Stephen E. Attwood, Alex Straumann, Seema S. Aceves, Jeffrey A. Alexander, Dan Atkins, Nicoleta C. Arva, Carine Blanchard, Peter A. Bonis, Wendy M. Book, Kelley E. Capocelli, Mirna Chehade, Edaire Cheng, Margaret H. CollinsCarla M. Davis, Jorge A. Dias, Carlo Di Lorenzo, Ranjan Dohil, Christophe Dupont, Gary W. Falk, Cristina T. Ferreira, Adam Fox, Nirmala P. Gonsalves, Sandeep K. Gupta, David A. Katzka, Yoshikazu Kinoshita, Calies Menard-Katcher, Ellyn Kodroff, David C. Metz, Stephan Miehlke, Amanda B. Muir, Vincent A. Mukkada, Simon Murch, Samuel Nurko, Yoshikazu Ohtsuka, Rok Orel, Alexandra Papadopoulou, Kathryn A. Peterson, Hamish Philpott, Philip E. Putnam, Joel E. Richter, Rachel Rosen, Marc E. Rothenberg, Alain Schoepfer, Melissa M. Scott, Neil Shah, Javed Sheikh, Rhonda F. Souza, Mary J. Strobel, Nicholas J. Talley, Michael F. Vaezi, Yvan Vandenplas, Mario C. Vieira, Marjorie M. Walker, Joshua B. Wechsler, Barry K. Wershil, Ting Wen, Guang Yu Yang, Ikuo Hirano, Albert J. Bredenoord

Gastroenterology and Hepatology

Research output: Contribution to journal › Article › peer-review

242 Scopus citations

Abstract

Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm²) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.

Original language	English (US)
Pages (from-to)	1022-1033.e10
Journal	Gastroenterology
Volume	155
Issue number	4
DOIs	https://doi.org/10.1053/j.gastro.2018.07.009
State	Published - Oct 2018

Keywords

Diagnosis
Eosinophilic Esophagitis
Esophageal Eosinophilia
Proton Pump Inhibitor

ASJC Scopus subject areas

Hepatology
Gastroenterology

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10.1053/j.gastro.2018.07.009

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Dellon, E. S., Liacouras, C. A., Molina-Infante, J., Furuta, G. T., Spergel, J. M., Zevit, N., Spechler, S. J., Attwood, S. E., Straumann, A., Aceves, S. S., Alexander, J. A., Atkins, D., Arva, N. C., Blanchard, C., Bonis, P. A., Book, W. M., Capocelli, K. E., Chehade, M., Cheng, E., ... Bredenoord, A. J. (2018). Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology, 155(4), 1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009

Dellon, ES, Liacouras, CA, Molina-Infante, J, Furuta, GT, Spergel, JM, Zevit, N, Spechler, SJ, Attwood, SE, Straumann, A, Aceves, SS, Alexander, JA, Atkins, D, Arva, NC, Blanchard, C, Bonis, PA, Book, WM, Capocelli, KE, Chehade, M, Cheng, E, Collins, MH, Davis, CM, Dias, JA, Di Lorenzo, C, Dohil, R, Dupont, C, Falk, GW, Ferreira, CT, Fox, A, Gonsalves, NP, Gupta, SK, Katzka, DA, Kinoshita, Y, Menard-Katcher, C, Kodroff, E, Metz, DC, Miehlke, S, Muir, AB, Mukkada, VA, Murch, S, Nurko, S, Ohtsuka, Y, Orel, R, Papadopoulou, A, Peterson, KA, Philpott, H, Putnam, PE, Richter, JE, Rosen, R, Rothenberg, ME, Schoepfer, A, Scott, MM, Shah, N, Sheikh, J, Souza, RF, Strobel, MJ, Talley, NJ, Vaezi, MF, Vandenplas, Y, Vieira, MC, Walker, MM, Wechsler, JB, Wershil, BK, Wen, T, Yang, GY, Hirano, I & Bredenoord, AJ 2018, 'Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference', Gastroenterology, vol. 155, no. 4, pp. 1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009

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title = "Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference",

abstract = "Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.",

keywords = "Diagnosis, Eosinophilic Esophagitis, Esophageal Eosinophilia, Proton Pump Inhibitor",

author = "Dellon, {Evan S.} and Liacouras, {Chris A.} and Javier Molina-Infante and Furuta, {Glenn T.} and Spergel, {Jonathan M.} and Noam Zevit and Spechler, {Stuart J.} and Attwood, {Stephen E.} and Alex Straumann and Aceves, {Seema S.} and Alexander, {Jeffrey A.} and Dan Atkins and Arva, {Nicoleta C.} and Carine Blanchard and Bonis, {Peter A.} and Book, {Wendy M.} and Capocelli, {Kelley E.} and Mirna Chehade and Edaire Cheng and Collins, {Margaret H.} and Davis, {Carla M.} and Dias, {Jorge A.} and {Di Lorenzo}, Carlo and Ranjan Dohil and Christophe Dupont and Falk, {Gary W.} and Ferreira, {Cristina T.} and Adam Fox and Gonsalves, {Nirmala P.} and Gupta, {Sandeep K.} and Katzka, {David A.} and Yoshikazu Kinoshita and Calies Menard-Katcher and Ellyn Kodroff and Metz, {David C.} and Stephan Miehlke and Muir, {Amanda B.} and Mukkada, {Vincent A.} and Simon Murch and Samuel Nurko and Yoshikazu Ohtsuka and Rok Orel and Alexandra Papadopoulou and Peterson, {Kathryn A.} and Hamish Philpott and Putnam, {Philip E.} and Richter, {Joel E.} and Rachel Rosen and Rothenberg, {Marc E.} and Alain Schoepfer and Scott, {Melissa M.} and Neil Shah and Javed Sheikh and Souza, {Rhonda F.} and Strobel, {Mary J.} and Talley, {Nicholas J.} and Vaezi, {Michael F.} and Yvan Vandenplas and Vieira, {Mario C.} and Walker, {Marjorie M.} and Wechsler, {Joshua B.} and Wershil, {Barry K.} and Ting Wen and Yang, {Guang Yu} and Ikuo Hirano and Bredenoord, {Albert J.}",

note = "Publisher Copyright: {\textcopyright} 2018 AGA Institute",

year = "2018",

month = oct,

doi = "10.1053/j.gastro.2018.07.009",

language = "English (US)",

volume = "155",

pages = "1022--1033.e10",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "W.B. Saunders Ltd",

number = "4",

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TY - JOUR

T1 - Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis

T2 - Proceedings of the AGREE Conference

AU - Dellon, Evan S.

AU - Liacouras, Chris A.

AU - Molina-Infante, Javier

AU - Furuta, Glenn T.

AU - Spergel, Jonathan M.

AU - Zevit, Noam

AU - Spechler, Stuart J.

AU - Attwood, Stephen E.

AU - Straumann, Alex

AU - Aceves, Seema S.

AU - Alexander, Jeffrey A.

AU - Atkins, Dan

AU - Arva, Nicoleta C.

AU - Blanchard, Carine

AU - Bonis, Peter A.

AU - Book, Wendy M.

AU - Capocelli, Kelley E.

AU - Chehade, Mirna

AU - Cheng, Edaire

AU - Collins, Margaret H.

AU - Davis, Carla M.

AU - Dias, Jorge A.

AU - Di Lorenzo, Carlo

AU - Dohil, Ranjan

AU - Dupont, Christophe

AU - Falk, Gary W.

AU - Ferreira, Cristina T.

AU - Fox, Adam

AU - Gonsalves, Nirmala P.

AU - Gupta, Sandeep K.

AU - Katzka, David A.

AU - Kinoshita, Yoshikazu

AU - Menard-Katcher, Calies

AU - Kodroff, Ellyn

AU - Metz, David C.

AU - Miehlke, Stephan

AU - Muir, Amanda B.

AU - Mukkada, Vincent A.

AU - Murch, Simon

AU - Nurko, Samuel

AU - Ohtsuka, Yoshikazu

AU - Orel, Rok

AU - Papadopoulou, Alexandra

AU - Peterson, Kathryn A.

AU - Philpott, Hamish

AU - Putnam, Philip E.

AU - Richter, Joel E.

AU - Rosen, Rachel

AU - Rothenberg, Marc E.

AU - Schoepfer, Alain

AU - Scott, Melissa M.

AU - Shah, Neil

AU - Sheikh, Javed

AU - Souza, Rhonda F.

AU - Strobel, Mary J.

AU - Talley, Nicholas J.

AU - Vaezi, Michael F.

AU - Vandenplas, Yvan

AU - Vieira, Mario C.

AU - Walker, Marjorie M.

AU - Wechsler, Joshua B.

AU - Wershil, Barry K.

AU - Wen, Ting

AU - Yang, Guang Yu

AU - Hirano, Ikuo

AU - Bredenoord, Albert J.

PY - 2018/10

Y1 - 2018/10

N2 - Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.

AB - Background & Aims: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. Methods: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. Results: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. Conclusions: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.

KW - Diagnosis

KW - Eosinophilic Esophagitis

KW - Esophageal Eosinophilia

KW - Proton Pump Inhibitor

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DO - 10.1053/j.gastro.2018.07.009

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AN - SCOPUS:85053196870

SN - 0016-5085

VL - 155

SP - 1022-1033.e10

JO - Gastroenterology

JF - Gastroenterology

IS - 4

ER -

Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference

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