A treatment course of PPIs should not be used as a diagnostic test for Eosinophilic Oesophagitis (EoE)
Updated international consensus diagnostic criteria for eosinophilic esophagitis: Proceedings of the AGREE conference Evan S. Dellon, Chris A. Liacouras, Javier Molina-Infante, Glenn T. Furuta et al Gastroenterology 2018
Continued: ‘Over the last decade, several clinical experience and research studies have raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). A consensus conference was convened to address the issue of PPI use for oesophageal eosinophilia
Substantial evidence documented that PPIs reduce oesophageal 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
EoE should only be diagnosed when there are symptoms of oesophageal dysfunction and at least 15 eosinophils per high-power field (or ~60 eosinophils per mm2) on oesophageal biopsy, and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to oesophageal eosinophilia
The consensus group gave the following rationale for their decision – there are similarities between EoE and PPI-REE, EoE and GORD but are not necessarily mutually exclusive, there is a lack of a gold standard for GORD diagnosis and, finally, there was concern about using a treatment response to define a disease.’
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