Eosinophilic esophagitis: Updated consensus recommendations for children and adults

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• 作者：Chris A. Liacouras MD ; ^{liacouras@email.chop.edu" rel="nofollow} ; Glenn T. Furuta MD ; Ikuo Hirano MD ; Dan Atkins MD ; Stephen E. Attwood MD ; FRCS ; FRCSI ; MCh ; Peter A. Bonis MD ; A. Wesley Burks MD ; Mirna Chehade MD ; Margaret H. Collins MD ; Evan S. Dellon MD ; MPH ; Ranjan Dohil MD ; Gary W. Falk MD ; MS ; Nirmala Gonsalves MD ; Sandeep K. Gupta MD ; David A. Katzka MD ; Alfredo J. Lucendo MD ; PhD ; Jonathan E. Markowitz MD ; MSCE ; Richard J. Noel MD ; Robert D. Odze MD ; FRCP ; Philip E. Putnam MD ; FAAP ; Joel E. Richter MD ; FACP ; MACG ; Yvonne Romero MD ; Eduardo Ruchelli MD ; Hugh A. Sampson MD ; Alain Schoepfer MD ; Nicholas J. Shaheen MD ; MPH ; Scott H. Sicherer MD ; Stuart Spechler MD ; Jonathan M. Spergel MD ; PhD ; Alex Straumann MD ; Barry K. Wershil MD ; Marc E. Rothenberg MD ; PhD^* ; Seema S. Aceves MD ; PhD^*
• 关键词：Eosinophils ; eosinophilic ; esophagitis ; esophageal ; food allergy
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：128
• 期：1
• 页码：3-20.e6
• 全文大小：688 K

文摘

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.