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

ABSTRACT: 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, teleconferences, 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 mm2) 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.

SUBMITTER: Dellon ES

PROVIDER: S-EPMC6174113 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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

Dellon Evan S ES Liacouras Chris A CA Molina-Infante Javier J Furuta Glenn T GT Spergel Jonathan M JM Zevit Noam N Spechler Stuart J SJ Attwood Stephen E SE Straumann Alex A Aceves Seema S SS Alexander Jeffrey A JA Atkins Dan D Arva Nicoleta C NC Blanchard Carine C Bonis Peter A PA Book Wendy M WM Capocelli Kelley E KE Chehade Mirna M Cheng Edaire E Collins Margaret H MH Davis Carla M CM Dias Jorge A JA Di Lorenzo Carlo C Dohil Ranjan R Dupont Christophe C Falk Gary W GW Ferreira Cristina T CT Fox Adam A Gonsalves Nirmala P NP Gupta Sandeep K SK Katzka David A DA Kinoshita Yoshikazu Y Menard-Katcher Calies C Kodroff Ellyn E Metz David C DC Miehlke Stephan S Muir Amanda B AB Mukkada Vincent A VA Murch Simon S Nurko Samuel S Ohtsuka Yoshikazu Y Orel Rok R Papadopoulou Alexandra A Peterson Kathryn A KA Philpott Hamish H Putnam Philip E PE Richter Joel E JE Rosen Rachel R Rothenberg Marc E ME Schoepfer Alain A Scott Melissa M MM Shah Neil N Sheikh Javed J Souza Rhonda F RF Strobel Mary J MJ Talley Nicholas J NJ Vaezi Michael F MF Vandenplas Yvan Y Vieira Mario C MC Walker Marjorie M MM Wechsler Joshua B JB Wershil Barry K BK Wen Ting T Yang Guang-Yu GY Hirano Ikuo I Bredenoord Albert J AJ

Gastroenterology 20180906 4

<h4>Background & aims</h4>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.<h4>Methods</h4>A consensus conference was convened to address the issue of PPI use for esophage ...[more]

PMID: 30009819

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Project description:Human herpesvirus-8 (HHV-8)-negative, idiopathic multicentric Castleman disease (iMCD) is a rare and life-threatening disorder involving systemic inflammatory symptoms, polyclonal lymphoproliferation, cytopenias, and multiple organ system dysfunction caused by a cytokine storm often including interleukin-6. iMCD accounts for one third to one half of all cases of MCD and can occur in individuals of any age. Accurate diagnosis is challenging, because no standard diagnostic criteria or diagnostic biomarkers currently exist, and there is significant overlap with malignant, autoimmune, and infectious disorders. An international working group comprising 34 pediatric and adult pathology and clinical experts in iMCD and related disorders from 8 countries, including 2 physicians that are also iMCD patients, was convened to establish iMCD diagnostic criteria. The working group reviewed data from 244 cases, met twice, and refined criteria over 15 months (June 2015 to September 2016). The proposed consensus criteria require both Major Criteria (characteristic lymph node histopathology and multicentric lymphadenopathy), at least 2 of 11 Minor Criteria with at least 1 laboratory abnormality, and exclusion of infectious, malignant, and autoimmune disorders that can mimic iMCD. Characteristic histopathologic features may include a constellation of regressed or hyperplastic germinal centers, follicular dendritic cell prominence, hypervascularization, and polytypic plasmacytosis. Laboratory and clinical Minor Criteria include elevated C-reactive protein or erythrocyte sedimentation rate, anemia, thrombocytopenia or thrombocytosis, hypoalbuminemia, renal dysfunction or proteinuria, polyclonal hypergammaglobulinemia, constitutional symptoms, hepatosplenomegaly, effusions or edema, eruptive cherry hemangiomatosis or violaceous papules, and lymphocytic interstitial pneumonitis. iMCD consensus diagnostic criteria will facilitate consistent diagnosis, appropriate treatment, and collaborative research.

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

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

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