@article{3107018,
    title = "Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference",
    author = "Dellon, E.S. and Liacouras, C.A. and Molina-Infante, J. and Furuta, G.T. and Spergel, J.M. and Zevit, N. and Spechler, S.J. and Attwood, S.E. and Straumann, A. and Aceves, S.S. and Alexander, J.A. and Atkins, D. and Arva, N.C. and Blanchard, C. and Bonis, P.A. and Book, W.M. and Capocelli, K.E. and Chehade, M. and Cheng, E. and Collins, M.H. and Davis, C.M. and Dias, J.A. and Di Lorenzo, C. and Dohil, R. and Dupont, C. and Falk, G.W. and Ferreira, C.T. and Fox, A. and Gonsalves, N.P. and Gupta, S.K. and Katzka, D.A. and Kinoshita, Y. and Menard-Katcher, C. and Kodroff, E. and Metz, D.C. and Miehlke, S. and Muir, A.B. and Mukkada, V.A. and Murch, S. and Nurko, S. and Ohtsuka, Y. and Orel, R. and Papadopoulou, A. and Peterson, K.A. and Philpott, H. and Putnam, P.E. and Richter, J.E. and Rosen, R. and Rothenberg, M.E. and Schoepfer, A. and Scott, M.M. and Shah, N. and Sheikh, J. and Souza, R.F. and Strobel, M.J. and Talley, N.J. and Vaezi, M.F. and Vandenplas, Y. and Vieira, M.C. and Walker, M.M. and Wechsler, J.B. and Wershil, B.K. and Wen, T. and Yang, G.-Y. and Hirano, I. and Bredenoord, A.J.",
    journal = "BMJ Open Gastroenterology",
    year = "2018",
    volume = "155",
    number = "4",
    pages = "1022-1033.e10",
    publisher = "W.B. Saunders",
    doi = "10.1053/j.gastro.2018.07.009",
    keywords = "proton pump inhibitor;  proton pump inhibitor, abdominal pain;  algorithm;  asthma;  atopic dermatitis;  clinical practice;  Conference Paper;  disease association;  dysphagia;  eosinophilic esophagitis;  epigastric pain;  esophagus biopsy;  family history;  follow up;  food allergy;  genetic variability;  heartburn;  human;  malnutrition;  nausea and vomiting;  odynophagia;  practice guideline;  priority journal;  stakeholder engagement;  thorax pain;  treatment response;  vomiting;  consensus;  consensus development;  digestive system examination;  eosinophilic esophagitis;  gastroenterology;  predictive value;  prognosis;  standards, Algorithms;  Consensus;  Diagnostic Techniques, Digestive System;  Eosinophilic Esophagitis;  Gastroenterology;  Humans;  Predictive Value of Tests;  Prognosis;  Proton Pump Inhibitors",
    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. © 2018 AGA Institute"
}