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Guideline

Management of eosinophilic esophagitis (EoE)

Recommendations for allergists and gastroenterologists focusing on the clinical management of eosinophilic esophagitis (EoE) for pediatric and adult patients.

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Recommendations

1. In patients with symptomatic esophageal eosinophilia, AGA and the Joint Task Force on Allergy-Immunology Practice Parameters (JTF) suggests using proton pump inhibition over no treatment.

2. In patients with eosinophilic esophagitis (EoE), AGA/JTF recommends topical glucocorticosteroids over no treatment.

3. In patients with EoE, AGA/JTF suggests topical glucocorticosteroids rather than oral glucocorticosteroids.

4. In patients with EoE, AGA/JTF suggests using elemental diet over no treatment.

5. In patients with EoE, AGA/JTF suggests using an empiric, six-food elimination diet over no treatment.

6. In patients with EoE, AGA/JTF suggests using an allergy testing-based elimination diet over no treatment.

7. In patient with EoE in remission after short-term use of topical glucocorticosteroids, AGA/JTF suggests continuation of topical glucocorticosteroids over discontinuation of treatment.

8. In adult patients with dysphagia from a stricture associated with EoE, AGA/JTF suggests endoscopic dilation over no dilation.

9. In patients with EoE, AGA/JTF recommends using anti–IL-5 therapy for EoE only in the context of a clinical trial.

10. In patients with EoE, AGA/JTF recommends using anti-IL-13 or anti-IL-4 receptor α therapy for EoE only in the context of a clinical trial.

11. In patients with EoE, AGA/JTF suggests against the use of anti-IgE therapy for EoE.

12. In patients with EoE, AGA/JTF suggest using montelukast, cromolyn sodium, immunomodulators, and anti-TNF for EoE only in the context of a clinical trial.

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