BRAZILIAN GASTROENTEROLOGY FEDERATION (FBG) CLINICAL GUIDELINE: DIAGNOSIS AND TREATMENT OF EOSINOPHILIC ESOPHAGITIS IN ADULTS AND ADOLESCENTS

Diretrizes da Federação Brasileira de Gastroenterologia (FBG) para o diagnóstico e tratamento da esofagite eosinofílica em adultos e adolescentes

ABSTRACT

Background:   Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects both children and adults.

Objective:   The purpose of this article is to establish guidance and updates for the diagnosis and treatment of EoE.

Methods:   The Brazilian Federation of Gastroenterology, FBG, gathered a group of gastroenterology experts in the field of esophagus and conducted a Delphi process to develop updated guideline for the management of patients with EoE in the light of recent evidence. Grading of the strength and quality of evidence of the recommendations was performed using GRADE criteria. The database searched included MEDLINE, EMBASE, SciELO, LILACS, ClinicalTrials.gov, and CINAHL, using their respective search mechanisms with studies retrieved up to January 2025. The resulting document is presented in the form of 15 questions and answers on diagnosis and treatment, with practical approaches and particularities of EoE, based on the current best evidence-based medicine, indicating the quality of data and specialists’ opinion on the subject.

Results:   From the standpoint of diagnosis, the present clinical guideline focused on the most prevalent aspects of EoE as well aiming to promote the benefits of the early diagnosis in clinical practice. The treatment is herein focused on the major advances in pharmacologic approach and therapeutic options available, as well as in the consistent corpus of evidence on dietary therapy.

Conclusion:  This FBG guideline is established to support clinical practice and suggest preferable approaches to a typical patient with EoE based on the currently available published literature. In this context, physicians must take into account patient´s medical comorbidities, adherence to treatment and preferences.

Keywords:
Eosinophilic esophagitis; diagnosis; treatment; complications

HIGHLIGHTS

• The purpose of this guideline is to provide recommendations on the diagnosis and treatment of EoE based on the available current evidence.

• The diagnosis must meet all three domains of the disease: clinical, endoscopic and histologic findings.

• Options to treatment are elimination diets, swalled topical corticosteroids, proton pump inhibitors and biological therapy as dupilumab. Emphasis should be given to the maintenance treatment for all patients.