Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).

Matjaz Homan, Tsili Zangen, Saskia Vande Velde, Sebastian Otte, Aco Kostovski, Roger Garcia-Puig, Sonia Férnandez Férnandez, Gloria Dominguez Ortega, Olivia Bauraind, Danielle Nijenhuis-Hendriks, Vaidotas Urbonas, Eleftheria Roma, Francesca Rea, Alexandra Papadopoulou, Sonny Chong, Marcus Karl-Heinz Auth, Nicolas Kalach, Caterina Strisciuglio, Salvatore Oliva, Claudio Romano, Mike Thomson, Christos Tzivinikos, Carolina Gutiérrez-Junquera, Koen Huysentruyt, Frederic Gottrand, Rok Orel, Noam Zevit, Mark Furman, Jorge Amil-Dias

Journal: Journal of pediatric gastroenterology and nutrition 2024;79(2):394-437

PMID: 38923067

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Abstract

INTRODUCTION

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary.

METHODS

A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations.

RESULTS

A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline.

CONCLUSION

Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE.

Address: Pediatric Gastroenterology, Hospital Lusíadas, Porto, Portugal.; Maternal and Child Health Department, University Hospital - Umberto I, Sapienza - University of Rome, Rome, Italy.; Division of Gastroenterology and Hepatology, First Department of Pediatrics, Children's hospital Agia Sofia, University of Athens, Athens, Greece.; Centre for Paediatric Gastroenterology, International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, UK.; Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Spain.; Department of Pediatrics, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France.; Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.; Alder Hey Children's NHS Foundation Trust, Liverpool, UK.; Juliana Children's Hospital/Haga, The Hague, The Netherlands.; Department of Woman, Child and General and Specialized Surgery of the University of Campania "Luigi Vanvitelli", Naples, Italy.; CHC Mont Legia, Liege, Belgium.; Epsom and St Helier University Hospitals NHS Trust, UK.; Pediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.; Pediatric Gastroenterology Unit, Department of Pediatrics, Severo Ochoa University Hospital, Madrid, Spain.; Royal Free London NHS Foundation Trust, London, UK.; Pediatric Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain.; CHU Lille, Univ. Lille, Infinite Inserm, Lille, France.; Kindergastro-enterologie, hepatologie en nutritie, Brussels Centre for Intestinal Rehabilitation in Children (BCIRC), Belgium.; University Children's Hospital Skopje, Faculty of Medicine, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia.; Childrens' Hospital, Helios Mariahilf Hospital, Hamburg, Germany.; Endoscopy and Surgey Unit, Bambino Gesu Children's Hospital, Rome, Italy.; First Department of Pediatrics, University of Athens and Pediatric Gastroenterology Unit Mitera Children's Hospital, Athens, Greece.; Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.; Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, UAE.; Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.; Vilnius University Medical Faculty Clinic of Children's Diseases, Vilnius, Lithuania.; Pediatric Gastroenterology, Ghent University Hospital, Belgium.; Pediatric Gastroenterology Unit, Wolfson Medical Center, Holon, Israel.; Eosinophilic Gastrointestinal Disease Clinic, Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Israel.

DOI: 10.1002/jpn3.12188

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MeSH Terms: Humans, Eosinophilic Esophagitis, Child, Gastroenterology, Europe, Societies, Medical