British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Abstract

BackgroundEosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.MethodsThe Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.ResultsFifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.ConclusionsThese comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

Assessment of Esophageal Motility in Patients With Eosinophilic Esophagitis

“…It is established that the lead time to securing a diagnosis of EoE can be prolonged and will differ in length, severity, and consequence in the different study groups. Disease duration is challenging to assess, with patients often developing adaptive strategies for eating, making the true start of the problem difficult even for the patient to determine 70. There is also a lack of data on disease activity at the time of motility investigations in the reported literature.…”

“…Disease duration is challenging to assess, with patients often developing adaptive strategies for eating, making the true start of the problem difficult even for the patient to determine. 70 There is also a lack of data on disease activity at the time of motility investigations in the reported literature. Particularly for retrospective cohorts, as described above, testing may tend toward periods where patients are refractory to treatment, thus representing the most severe and long-standing disease.…”

Randomised clinical trial: the use of alginates during preinvestigation proton pump inhibitor wash-out and their impact on compliance and symptom burden

“…For the diagnosis of eosinophilic oesophagitis, PPIs have been shown to supress eosinophilia such that recent consensus guidelines recommend stopping PPIs for at least 3 weeks prior to biopsy to ensure accurate diagnosis. 32 Finally, although unusual, there are reports of PPIs masking early gastric and oesophageal adenocarcinoma. 33 Census data showed that over 800 000 gastroscopies were performed in 2019 in England.…”

Eosinophilic Esophagitis in a 75-Year-Old Saudi Man: A Case Report

“…Eosinophilic esophagitis (EoE) is being increasingly acknowledged as a common cause of upper gastrointestinal (GI) morbidity in both children and adults [1][2][3]. First described as a distinct esophageal disease in the mid-1990s, emerging evidence suggests that EoE is more widespread than originally believed [4].…”

“…A recent study conducted in the Danish general population reported the prevalence of EoE as 69.7 per 100,000 people [5]. Traditionally, EoE has been considered predominately to affect males, children, and young adults [3,6]. Indeed, EoE is most often seen in men aged between 20 and 50 years [1].…”