Table 3.

American Gastroenterological Institute and Joint Task Force on Allergy-Immunology Practice Parameters Guideline Recommendations on the Management of Eosinophilic Esophagitis

Recommendation	Strength of recommendation	Quality of evidence
1. Recommendation: In patients with symptomatic esophageal eosinophilia, the AGA/JTF suggests using proton pump inhibition over no treatment.	Conditional	Very low quality
2. In patients with EoE, the AGA/JTF recommends topical glucocorticosteroids over no treatment.	Strong	Moderate
3. In patients with EoE, the AGA/JTF suggests topical glucocorticosteroids rather than oral glucocorticosteroids.	Conditional	Moderate
4. In patients with EoE, the AGA/JTF suggests using elemental diet over no treatment. Comment: Patients who put a higher value on avoiding the challenges of adherence to an elemental diet and the prolonged process of dietary reintroduction may reasonably decline this treatment option.	Conditional	Moderate
5. In patients with EoE, the AGA/JTF suggests using an empiric, 6-food elimination diet over no treatment. Comment: Patients who put a higher value on avoiding the challenges of adherence to diet involving elimination of multiple common food staples and the prolonged process of dietary reintroduction may reasonably decline this treatment option.	Conditional	Low
6. In patients with EoE, the AGA/JTF suggests using an allergy testing-based elimination diet over no treatment. Comment: Due to the potential limited accuracy of currently available, allergy-based testing for the identification of specific food triggers for EoE, patients may prefer alternative medical or dietary therapies to an exclusively testing-based elimination diet.	Conditional	Very low quality
7. Recommendation: In patient with EoE in remission after short-term use of topical glucocorticosteroids, the AGA/JTF suggests continuation of topical glucocorticosteroids over discontinuation of treatment. Comments: Patients who put a high value on the avoidance of long-term topical steroid use and its possible associated adverse effects, and/or place a lower value on the prevention of potential long-term undesirable outcomes (ie, recurrent dysphagia, food impaction, and esophageal stricture), could reasonably prefer cessation of treatment after initial remission is achieved, provided clinical follow-up is maintained.	Conditional	Very low quality
8. Recommendation: In adult patients with dysphagia from a stricture associated with EoE, the AGA/JTF suggests endoscopic dilation over no dilation. Comment: Esophageal dilation does not address the esophageal inflammation associated with EoE.	Conditional	Very low quality
9. Recommendation: In patients with EoE, the AGA/JTF recommends using anti–IL-5 therapy for EoE only in the context of a clinical trial.	No recommendation	Knowledge gap
10. Recommendation: In patients with EoE, the AGA/JTF recommends using anti–IL-13 or anti–IL-4 receptor α therapy for EoE only in the context of a clinical trial.	No recommendation	Knowledge gap
11. Recommendation: In patients with EoE, the AGA/JTF suggests against the use of anti-IgE therapy for EoE.	Conditional	Very low quality
12–15. Recommendation: In patients with EoE the AGA/JTF suggest using montelukast, cromolyn sodium, immunomodulators, and anti-TNF for EoE only in the context of a clinical trial.	No recommendation	Knowledge gap