Updated Guidelines for the Diagnosis and Management of Eosinophilic Esophagitis (EoE)

In January, the American College of Gastroenterology released updated clinical guidelines for healthcare providers regarding the diagnosis and management of eosinophilic esophagitis (EoE).

Previous guidelines were published in 2013. Since then, there have been major breakthroughs in understanding EoE and how to treat it. We’ve learned more about what increases the risk of EoE, how it develops over time, and what causes it. There are also new ways to measure treatment success, a system to classify how severe the disease is, and updated language used to describe eosinophilic gastrointestinal diseases. The updated guidelines also include recommendations specific to children with EoE.

Highlights of the 19 recommendations in the updated guidelines include:

• Recommendation for diagnosing EoE by checking for symptoms of esophageal dysfunction, such as trouble swallowing or regurgitating food, finding 15 or more eosinophils per high powered field in the esophageal tissue samples taken during biopsy, and ruling out other possible conditions.
• Recommendation to use a standard scoring system during every endoscopy and to take at least six tissue samples (biopsies) from at least two parts of the esophagus to be examined under a microscope.
• To treat EoE, the guideline supports the use of medical therapy including proton pump inhibitors (PPIs) or swallowed topical steroids or diet elimination of allergens. If patients do not respond to these approaches, the biologic, dupilumab can be used.
• For children with EoE and feeding difficulties, a feeding therapist or dietitian to help with therapy is recommended.
• Doctors should check how well treatments are working by monitoring symptoms and performing endoscopies with biopsies so that the tissue samples can be examined under a microscope.
• The guidelines indicate it is important for doctors to address both the inflammation and any scarring or narrowing of the esophagus when treating and monitoring patients with EoE.

Citation: Dellon, Evan S. MD, MPH, FACG1; Muir, Amanda B. MD2,3,4; Katzka, David A. MD, FACG5; Shah, Shailja C. MD, MPH6,7; Sauer, Bryan G. MD, MSc, FACG8; Aceves, Seema S. MD, PhD9,10; Furuta, Glenn T. MD11,12; Gonsalves, Nirmala MD, FACG13,*; Hirano, Ikuo MD, FACG13,*,†. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. The American Journal of Gastroenterology 120(1):p 31-59, January 2025. | DOI: 10.14309/ajg.0000000000003194

Related Links

Full publication, of guidelines for healthcare professionals

Visual summary of guidelines for healthcare professionals

ACG podcast with an author of the guidelines, titled ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis