ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)

Am J Gastroenterol. 2013 May;108(5):679-92; quiz 693. doi: 10.1038/ajg.2013.71. Epub 2013 Apr 9.


Esophageal eosinophilia and eosinophilic esophagitis (EoE) are increasingly recognized and prevalent conditions, which now represent common clinical problems encountered by gastroenterologists, pathologists, and allergists. The study of EoE has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Although there are limited data supporting management decisions, clinical parameters are needed to guide the care of patients with eosinophilic-esophageal disorders. In this evidence-based review, recommendations developed by adult and pediatric gastroenterologists are provided for the evaluation and management of these patients. New terminology is emphasized, particularly the concepts of esophageal eosinophilia and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) as entities distinct from EoE.

Publication types

  • Practice Guideline
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms
  • Androstadienes / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use*
  • Biopsy
  • Clinical Trials as Topic
  • Diagnosis, Differential
  • Endpoint Determination
  • Eosinophilia / diagnosis
  • Eosinophilia / pathology
  • Eosinophilic Esophagitis / complications
  • Eosinophilic Esophagitis / diagnosis*
  • Eosinophilic Esophagitis / pathology
  • Eosinophilic Esophagitis / therapy*
  • Esophagoscopy*
  • Esophagus / pathology*
  • Evidence-Based Medicine
  • Fluticasone
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / therapy
  • Humans
  • Prednisone / therapeutic use
  • Proton Pump Inhibitors / therapeutic use*


  • Androstadienes
  • Anti-Inflammatory Agents
  • Proton Pump Inhibitors
  • Fluticasone
  • Prednisone