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Eosinophilic Esophagitis: Diagnostic Criteria and Recommendations

The first consensus recommendations for eosinophilic esophagitis were derived from the first symposium held by The International Gastrointestinal Eosinophil Researchers (TIGER), which was comprised of several members of the CCED faculty. These guidelines were published in 2007 as Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment.

These original consensus guidelines for eosinophilic esophagitis were reviewed and updated in 2011 and published as Eosinophilic esophagitis: updated consensus recommendations for children and adults, with several members of the CCED faculty contributing in this endeavor.

 

Suggested Literature

Doctors who study eosinophils at Cincinnati Children’s Hospital Medical Center recommend the following journal articles for more information about research about eosinophilic disorders.

2012

Hommel KA, Franciosi JP, Hente EA, Ahrens A, Rothenberg ME. Treatment adherence in pediatric eosinophilic gastrointestinal disorders. J Pediatr Psychol. [Epub ahead of print]

Franciosi JP, Hommel KA, Debrosse CW, Greenberg AB, Greenler AJ, Abonia JP, Rothenberg ME, Varni JW. Quality of life in paediatric eosinophilic oesophagitis: what is important to patients? Child Care Health Dev.  [Epub ahead of print]

Spergel JM, Rothenberg ME, Collins MH, Furuta GT, Markowitz JE, Fuchs G 3rd, O’Gorman MA, Abonia JP, Young J, Henkel T, Wilkins HJ, Liacouras CA. Reslizumab in children and adolescents with eosinophilic esophagitis: Results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2012;129(2):456-463.e3.

Wen T, Mingler MK, Blanchard C, Wahl B, Pabst O, Rothenberg ME. The Pan-B Cell Marker CD22 Is Expressed on Gastrointestinal Eosinophils and Negatively Regulates Tissue Eosinophilia. J Immunol. 2012;188(3):1075-82.

Abonia JP, Rothenberg ME. Eosinophilic Esophagitis: Rapidly Advancing Insights. Annu Rev Med. 2012;18(63):421-34.

2011

Franciosi JP, Hommel KA, Debrosse CW, Greenberg AB, Greenler AJ, Abonia JP, Rothenberg ME, Varni JW. Development of a validated patient-reported symptom metric for pediatric eosinophilic esophagitis: qualitative methods. BMC Gastroenterol. 2011;11:126.

Debrosse CW, Franciosi JP, King EC, Buckmeier Butz BK, Greenberg AB, Collins MH, Abonia JP, Assa’ad A, Putnam PE, Rothenberg ME. Long-term outcomes in pediatric-onset esophageal eosinophilia. J Allergy Clin Immunol. 2011;128(1):132-8.

Sherrill JD, Rothenberg ME. Genetic dissection of eosinophilic esophagitis provides insight into disease pathogenesis and treatment strategies. J Allergy Clin Immunol. 2011;128(1):23-32; quiz 33-4.

Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011; 128(1):3-20.e6; quiz 21-2.

Lacy P, Willetts L, Kim JD, Lo AN, Lam B, Maclean EI, Moqbel R, Rothenberg ME, Zimmermann N. Agonist Activation of F-Actin-Mediated Eosinophil Shape Change and Mediator Release Is Dependent on Rac2. Int Arch Allergy Immunol. 2011;156(2):137-147.

Waddell A, Ahrens R, Steinbrecher K, Donovan B, Rothenberg ME, Munitz A, Hogan SP.Colonic eosinophilic inflammation in experimental colitis is mediated by Ly6C(high) CCR2(+) inflammatory monocyte/macrophage-derived CCL11. J Immunol. 2011;186(10):5993-6003.

Eom CS, Park SM, Myung SK, Yun JM, Ahn JS. Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann Fam Med. 2011;9(3):257-67.

Eosinophilic Esophagitis by Dr. Glenn Furuta. Reprinted from Food Allergy News, Vol. 20, No. 4, copyright 2011, The Food Allergy & Anaphylaxis Network (FAAN). Posted with permission.

Lim EJ, Lu TX, Blanchard C, Rothenberg ME. Epigenetic regulation of the IL-13-induced human eotaxin-3 gene by CBP-mediated histone 3 acetylation. J Biol Chem. 2011;286(15):13193-13204.

Broide DH, Finkelman F, Bochner BS, Rothenberg ME. Advances in mechanisms of asthma, allergy, and immunology in 2010. J Allergy Clin Immunol. 2011;127(3):689-95.

Baye TM, Butsch Kovacic M, Biagini Myers JM, Martin LJ, Lindsey M, Patterson TL, He H, Ericksen MB, Gupta J, Tsoras AM, Lindsley A, Rothenberg ME, Wills-Karp M, Eissa NT, Borish L, Khurana Hershey GK. Differences in Candidate Gene Association between European Ancestry and African American Asthmatic Children. PLoS One. 2011;6(2):e16522.

Mulder DJ, Justinich CJ. Understanding eosinophilic esophagitis: the cellular and molecular mechanisms of an emerging disease. Mucosal Immunol. 2011:4(2):139-47.

Blanchard C, Stucke EM, Rodriguez-Jimenez B, Burwinkel K, Collins MH, Ahrens A, Alexander ES, Butz BK, Jameson SC, Kaul A, Franciosi JP, Kushner JP, Putnam PE, Abonia JP, Rothenberg ME. A striking local esophageal cytokine expression profile in eosinophilic esophagitis. J Allergy Clin Immunol. 2011;127(1):208-17, 217.e1-7.

Miles MV, Putnam PE, Miles L, Tang PH, Degrauw AJ, Wong BL, Horn PS, Foote HL, Rothenberg ME. Acquired coenzyme Q10 deficiency in children with recurrent food intolerance and allergies. Mitochondrion. 2011;11(1):127-35.

Kwiatek MA, Hirano I, Kahrilas PJ, Rothe J, Luger D, Pandolfino JE. Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology. 2011;140(1):82-90.

2010

Abonia JP, Franciosi JP, Rothenberg ME. TGF-beta1: Mediator of a feedback loop in eosinophilic esophagitis − or should we really say mastocytic esophagitis? J Allergy Clin Immunol. 2010;126(6):1205-7.

Cortina S, McGraw K, deAlarcon A, Ahrens A, Rothenberg ME, Drotar D. Psychological functioning of children and adolescents with eosinophil-associated gastrointestinal disorders. Children’s Health Care. 2010; 39(4):266-78.

Voelker R. Researchers look to genetic analyses for new options in treating food allergy. JAMA. 2010; 304(18):2001.

Straumann A, Conus S, Degen L, Felder S, Kummer M, Engel H, Bussmann C, Beglinger C, Schoepfer A, Simon HU. Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis.Gastroenterology. 2010;139(5):1526-1537.e1.

Finkelman FD, Boyce JA, Vercelli D, Rothenberg ME. Key advances in mechanisms of asthma, allergy, and immunology in 2009.J Allergy Clin Immunol. 2010;125(2):312-8.

Munitz A, Cole ET, Waddell A, Groschwitz K, Ahrens R, Steinbrecher K, Willson T, Han X, Denson L, Rothenberg ME, Hogan SP. Paired immunoglobulin-like Receptor B (PIR-B) Negatively Regulates Macrophage Activation in Experimental Colitis.Gastroenterology. 2010;139(2):530-41.

Rayapudi M, Mavi P, Zhu X, Pandey AK, Abonia JP, Rothenberg ME, Mishra A. Indoor insect allergens are potent inducers of experimental eosinophilic esophagitis in mice.J Leukoc Biol. 2010; 88(2):337-46.

Zhu X, Wang M, Mavi P, Rayapudi M, Pandey AK, Kaul A, Putnam PE, Rothenberg ME, Mishra A. Interleukin-15 expression is increased in human eosinophilic esophagitis and mediates pathogenesis in mice. Gastroenterology. 2010;139(1):182-93.e7.

Simon HU, Rothenberg ME, Bochner BS, Weller PF, Wardlaw AJ, Wechsler ME, Rosenwasser LJ, Roufosse F, Gleich GJ, Klion AD. Refining the definition of hypereosinophilic syndrome. J Allergy Clin Immunol. 2010;126(1):45-9.

Sherrill JD, Gao PS, Stucke EM, Blanchard C, Collins MH, Putnam PE, Franciosi JP, Kushner JP, Abonia JP, Assa’ad AH, Kovacic MB, Biagini Myers JM, Bochner BS, He H, Hershey GK, Martin LJ, Rothenberg ME. Variants of thymic stromal lymphopoietin and its receptor associate with eosinophilic esophagitis. J Allergy Clin Immunol. 2010;126(1):160-165.

DeBrosse CW, Collins MH, Buckmeier Butz BK, Allen CL, King EC, Assa’ad AH, Abonia JP, Putnam PE, Rothenberg ME, Franciosi JP. Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982-1999. J Allergy Clin Immunol. 2010;126(1):112-119.

Abonia JP, Blanchard C, Butz BB, Rainey HF, Collins MH, Stringer K, Putnam PE, Rothenberg ME. Involvement of mast cells in eosinophilic esophagitis.J Allergy Clin Immunol. 2010;126(1):140-9.

Simon D, Wardlaw A, Rothenberg, ME. Organ-specific eosinophilic disorders of the skin, lung, and gastrointestinal tract. J Allergy Clin Immunol. 2010; 126(1):3-13;quiz 14-5.

Zuo L, Fulkerson PC, Finkelman FD, Mingler M, Fischetti CA, Blanchard C, Rothenberg, ME. IL-13 induces esophageal remodeling and gene expression by an eosinophil-independent, IL-13R{alpha}2-inhibited pathway.J Immunol. 2010;185(1):660-9.

Caldwell JM, Blanchard C, Collins MH, Putnam PE, Kaul A, Aceves SS, Bouska CA, Rothenberg ME. Glucocorticoid-regulated genes in eosinophilic esophagitis: a role for FKBP51. J Allergy Clin Immunol. 2010;125(4):879-88 e8.

Blanchard C, Stucke EM, Burwinkel K, Caldwell JM, Collins MH, Ahrens A, Buckmeier BK, Jameson SC, Greenberg A, Kaul A, Franciosi JP, Kushner JP, Martin LF, Putnam PE, Abonia JP, Wells SI, Rothenberg ME. Coordinate interaction between IL-13 and epithelial differentiation cluster genes in eosinophilic esophagitis.J Immunol. 2010;184(7):4033-41.

Ingerski LM, Modi AC, Hood KK, Pai AL, Zeller M, Piazza-Waggoner C, Driscoll KA, Rothenberg ME, Franciosi J, Hommel KA. Health-related quality of life across pediatric chronic conditions. J Pediatr. 2010;156(4):639-44.

Rothenberg ME, Spergel JM, Sherrill JD, Annaiah K, Martin LJ, Cianferoni A, Gober L, Kim C, Glessner J, Fackelton E, Thomas K, Blanchard C, Liacouras C, Verma R, Aceves S, Collins MH, Brown-Whitehorn T, Putnam PE, Franciosi JP, Chiavacci RM, Grant SF, Abonia JP, Sleiman PM, Hakonarson H. Common variants at 5q22 associate with pediatric eosinophilic esophagitis. Nat Genet. 2010;42(4):289-91.

Vicario M, Blanchard C, Stringer KF, Collins MH, Mingler MK, Ahrens A, Putnam PE, Abonia JP, Santos J, Rothenberg ME. Local B cells and IgE production in the oesophageal mucosa in eosinophilic oesophagitis. Gut. 2010;59(1):12-20.

2009

Krarup AL, Villadsen GE, Mejlgaard E, Olesen SS, Drewes AM, Funch-Jensen P. Acid hypersensitivity in patients with eosinophilic oesophagitis. Scand J Gastroenterol. 2010 Mar;45(3):273-281. This is an interesting manuscript that demonstrates that the esophagus of EE patients is hypersensitive to acid exposure (as measured by time to heartburn).  Importantly, there is no differences in response to mechanical, thermal or electrical stimulation (markers of CNS sensitization), showing specificity of the response to acid. These results, combined with the recent findings that acid can increase eotaxin-3 release (Blanchard et al J Immunol; 2010;184:4033-41.), highlight the contribution of acid (reflux-associated acid or physiological acid) to EE. Based on this, the need to continue acid suppressive therapy in EE patients (regardless of GERD) should be considered.

Putnam PE, Rothenberg ME. Eosinophilic esophagitis: concepts, controversies, and evidenceCurr Gastroenterol Rep. 2009 Jun;11(3):220-5.

Qu Z, Kundu UR, Abadeer RA, Wanger A. Strongyloides colitis is a lethal mimic of ulcerative colitis: the key morphologic differential diagnosis. Hum Pathol. 2009 Apr;40(4):572-7. This article draws attention to the possibility that strongyloides infection can cause secondary eosinophilic colitis and should thus be in the differential diagnosis of EGID.

Brandt EB, Munitz A, Orekov T, Mingler MK, McBride M, Finkelman FD, Rothenberg ME. Targeting IL-4/IL-13 Signaling to Alleviate Oral Allergen-induced DiarrheaJ Allergy Clin Immunol. 2009 Jan;123(1):53-8.