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Non-esophageal eosinophilic gastrointestinal disorders

Key sources
The following summarized guidelines for the evaluation and management of non-esophageal eosinophilic gastrointestinal disorders are prepared by our editorial team based on guidelines from the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN/NASPGHAN 2024).
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Guidelines

1.Screening and diagnosis

Terminology: use the term non-esophageal eosinophilic gastrointestinal disorders to describe chronic inflammatory disorders of the gastrointestinal tract beyond the esophagus characterized clinically by the presence of gastrointestinal symptoms and histologically by eosinophilic predominant inflammation of the gastrointestinal tract, in the absence of an identifiable secondary cause.
A
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  • Diagnostic criteria

  • Differential diagnosis

2.Diagnostic investigations

General principles
Consider obtaining an initial evaluation in patients with symptoms suggestive of non-esophageal eosinophilic gastrointestinal disorders individualized based on history, clinical examination, and associated laboratory testing.
C
Consider using an algorithm to guide the diagnostic approach of pediatric and adolescent patients with symptoms suggestive of non-esophageal eosinophilic gastrointestinal disorders.
C

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  • Blood tests

  • Fecal calprotectin

  • Food allergy tests

  • Diagnostic imaging

3.Diagnostic procedures

Endoscopy and biopsy: guide the choice of endoscopic examinations of the gastrointestinal tract by symptoms, laboratory, and radiographic findings.
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  • Ascitic fluid analysis

4.Medical management

General principles: consider individualizing initial treatment in pediatric patients with non-esophageal eosinophilic gastrointestinal disorders based on symptoms, impact on growth and development, and other comorbid features with an attempt to involve patients and parents/caregivers in shared decision-making.
C
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  • Corticosteroids

  • Acid suppressive therapy

  • Combination therapy

  • Agents with no evidence for benefit

5.Nonpharmacologic interventions

Dietary modifications
Consider offering empiric elimination diets in selected patients with non-esophageal eosinophilic gastrointestinal disorders.
C
Avoid obtaining food allergy tests to guide dietary restriction therapy in patients with non-esophageal eosinophilic gastrointestinal disorders.
D

6.Therapeutic procedures

Endoscopic dilation: consider performing endoscopic dilation in addition to medical/dietary treatment in selected cases with significant objective signs of obstruction.
C

7.Surgical interventions

Indications for surgery: consider performing surgery in patients with non-esophageal eosinophilic gastrointestinal disorders with refractory ulcers, intestinal perforation, or bowel obstruction unable to be controlled otherwise.
C

8.Follow-up and surveillance

Serial laboratory assessment
Consider using peripheral eosinophilia when consistently associated with mucosal eosinophilia in individual patients as an adjunct to monitor non-esophageal eosinophilic gastrointestinal disorder disease activity.
C
Consider obtaining blood tests to monitor treatment responses in selected cases.
C

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  • Serial endoscopic assessment