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

被引：813

作者：

Dellon, Evan S. ^{[1
]}

Liacouras, Chris A. ^{[2
]}

Molina-Infante, Javier ^{[3
,4
]}

Furuta, Glenn T. ^{[5
,6
]}

Spergel, Jonathan M. ^{[7
]}

Zevit, Noam ^{[8
,9
]}

Spechler, Stuart J. ^{[10
,11
]}

Attwood, Stephen E. ^{[12
]}

Straumann, Alex ^{[13
]}

Aceves, Seema S. ^{[14
,15
,16
]}

Alexander, Jeffrey A. ^{[17
]}

Atkins, Dan ^{[18
,19
]}

Arva, Nicoleta C. ^{[20
]}

Blanchard, Carine ^{[21
]}

Bonis, Peter A. ^{[22
]}

Book, Wendy M. ^{[23
]}

Capocelli, Kelley E. ^{[24
]}

Chehade, Mirna ^{[25
]}

Cheng, Edaire ^{[26
,27
]}

Collins, Margaret H. ^{[28
]}

Davis, Carla M. ^{[29
]}

Dias, Jorge A. ^{[30
]}

Di Lorenzo, Carlo ^{[31
]}

Dohil, Ranjan ^{[32
]}

Dupont, Christophe ^{[33
]}

Falk, Gary W. ^{[34
]}

Ferreira, Cristina T. ^{[35
]}

Fox, Adam ^{[36
]}

Gonsalves, Nirmala P. ^{[37
]}

Gupta, Sandeep K. ^{[38
]}

Katzka, David A. ^{[17
]}

Kinoshita, Yoshikazu ^{[39
]}

Menard-Katcher, Calies ^{[5
,6
]}

Kodroff, Ellyn ^{[40
]}

Metz, David C. ^{[34
]}

Miehlke, Stephan ^{[41
]}

Muir, Amanda B. ^{[2
]}

Mukkada, Vincent A. ^{[42
]}

Murch, Simon ^{[43
]}

Nurko, Samuel ^{[44
]}

Ohtsuka, Yoshikazu ^{[45
]}

Orel, Rok ^{[46
]}

Papadopoulou, Alexandra ^{[47
]}

Peterson, Kathryn A. ^{[48
]}

Philpott, Hamish ^{[49
]}

Putnam, Philip E. ^{[42
]}

Richter, Joel E. ^{[50
]}

Rosen, Rachel ^{[51
]}

Rothenberg, Marc E. ^{[52
]}

Schoepfer, Alain ^{[53
,54
]}

机构：

[1] Univ N Carolina, Ctr Esophageal Dis & Swallowing, Div Gastroenterol & Hepatol, Sch Med, Chapel Hill, NC USA

[2] Univ Penn, Childrens Hosp Philadelphia, Div Gastroenterol & Hepatol & Nutr, Ctr Pediat Eosinophil Dis,Perelman Sch Med, Philadelphia, PA 19104 USA

[3] Hosp Univ San Pedro de Alcantara, Dept Gastroenterol, Caceres, Spain

[4] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[5] Childrens Hosp Colorado, Digest Hlth Inst, Aurora, CO USA

[6] Univ Colorado, Sch Med, Gastrointestinal Eosinophil Dis Program, Aurora, CO USA

[7] Univ Penn, Childrens Hosp Philadelphia, Ctr Pediat Eosinophil Dis, Div Allergy Immunol,Perelman Sch Med, Philadelphia, PA 19104 USA

[8] Schneider Childrens Med Ctr Israel, Inst Gastroenterol Nutr & Liver Dis, Petah Tiqwa, Israel

[9] Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel

[10] Baylor Univ, Med Ctr, Ctr Esophageal Dis, Dallas, TX USA

[11] Baylor Scott & White Res Inst, Ctr Esophageal Res, Dallas, TX USA

[12] Univ Durham, Dept Hlth Serv Res, Durham, England

[13] Swiss EoE Res Network, Olten, Switzerland

[14] Univ Calif San Diego, Dept Pediat, Div Allergy, Immunol, La Jolla, CA 92093 USA

[15] Univ Calif San Diego, Dept Med, Div Allergy, Immunol, La Jolla, CA 92093 USA

[16] Rady Childrens Hosp, La Jolla, CA USA

[17] Mayo Clin, Div Gastroenterol, Rochester, MN USA

[18] Childrens Hosp Colorado, Allergy & Immunol Sect, Aurora, CO USA

[19] Univ Colorado, Sch Med, Gastrointestinal Eosinophil Dis Program, Aurora, CO USA

[20] Northwestern Univ, Dept Pathol & Lab Med, Ann & Robert H Lurie Childrens Hosp Chicago, Feinberg Sch Med, Chicago, IL 60611 USA

[21] Nestle Res Ctr, Inst Nutr Sci, Vevey, Switzerland

[22] Tufts Univ, Sch Med, Div Gastroenterol, Boston, MA 02111 USA

[23] Amer Partnership Eosinophil Disorders, Atlanta, GA USA

[24] Childrens Hosp Colorado, Dept Pediat Pathol, Aurora, CO USA

[25] Icahn Sch Med Mt Sinai, Mt Sinai Ctr Eosinophil Disorders, New York, NY 10029 USA

[26] Univ Texas Southwestern Med Ctr Dallas, Dept Pediat, Childrens Med Ctr, Dallas, TX USA

[27] Univ Texas Southwestern Med Ctr Dallas, Dept Internal Med, Childrens Med Ctr, Dallas, TX USA

[28] Cincinnati Childrens Hosp Med Ctr, Div Pathol & Lab Med, Cincinnati, OH 45229 USA

[29] Texas Childrens Hosp, Baylor Coll Med, Allergy & Immunol Sect, Dept Pediat, Houston, TX 77030 USA

[30] Ctr Hosp S Joao, Pediat Gastroenterol, Porto, Portugal

[31] Ohio State Univ, Div Gastroenterol & Hepatol & Nutr, Nationwide Childrens Hosp, Columbus, OH 43210 USA

[32] Univ Calif San Diego, Div Gastroenterol & Hepatol, Rady Childrens Hosp, San Diego, CA 92103 USA

[33] Paris Descartes Univ, Necker Hosp, Paris, France

[34] Univ Penn, Div Gastroenterol, Perelman Sch Med, Philadelphia, PA 19104 USA

[35] Fed Univ Hlth Sci Porto Alegre, Hosp Santo Antonio, Porto Alegre, RS, Brazil

[36] Guys & St Thomas Hosp NHS Fdn Trust, Dept Paediat Allergy, London, England

[37] Northwestern Univ, Div Gastroenterol & Hepatol, Feinberg Sch Med, Chicago, IL 60611 USA

[38] Univ Illinois, Div Pediat Gastroenterol Hepatol & Nutr, Childrens Hosp Illinois, Peoria, IL USA

[39] Shimane Univ, Dept Gastroenterol & Hepatol, Sch Med, Izumo, Shimane, Japan

[40] Campaign Urging Res Eosinophil Dis, Lincolnshire, IL USA

[41] Internal Med Ctr, Ctr Digest Dis, Hamburg, Germany

[42] Cincinnati Childrens Hosp Med Ctr, Div Gastroenterol Hepatol & Nutr, Cincinnati, OH 45229 USA

[43] Univ Hosp Coventry & Warwickshire, Dept Paediat, Coventry, W Midlands, England

[44] Boston Childrens Hosp, Ctr Motil & Funct Gastrointestinal Disorders, Boston, MA USA

[45] Juntendo Univ, Dept Pediat & Adolescent Med, Grad Sch Med, Tokyo, Japan

[46] Univ Ljubljana, Univ Childrens Hosp, Fac Med, Ljubljana, Slovenia

[47] Univ Athens, Div Gastroenterol & Hepatol, Dept Pediat 1, Childrens Hosp Agia Sofia, Athens, Greece

[48] Univ Utah, Salt Lake City, UT USA

[49] Univ Adelaide, Northern Adelaide Local Hlth Network, Dept Gastroenterol, Adelaide, SA, Australia

[50] Univ S Florida, Morsani Coll Med, Tampa, FL USA

来源：

GASTROENTEROLOGY | 2018年 / 155卷 / 04期

关键词：

Diagnosis; Eosinophilic Esophagitis; Esophageal Eosinophilia; Proton Pump Inhibitor; PROTON-PUMP INHIBITOR; GASTROESOPHAGEAL-REFLUX DISEASE; DILATED INTERCELLULAR SPACES; FREE-RADICAL PRODUCTION; CASE SERIES; HISTOPATHOLOGIC VARIABILITY; SWALLOWED FLUTICASONE; ENDOSCOPIC FEATURES; PEDIATRIC-PATIENTS; CLINICAL-FEATURES;

D O I：

10.1053/j.gastro.2018.07.009

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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, tele-conferences, 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 mm(2)) 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.

引用

页码：1022 / +

页数：22

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