This position paper deals with an expert consensus on diagnosis and management of eosinophilic esophagitis and esophageal food impaction issued by the Austrian Eosinophilic Esophagitis Network, a working group under the patronage of the Austrian Society of Gastroenterology and Hepatology (ÖGGH). In need of a standardized approach on the management of EoE, recommendations were made based on international guidelines and landmark studies.

BACKGROUND: Nearly 80% of patients with eosinophilic esophagitis have co-existing atopic disease, yet a subset do not. It is unclear if this lack of atopy impacts presentation or response to therapy.
OBJECTIVE: To characterize the presentation and response to therapy in atopic versus non-atopic pediatric patients with EoE METHODS: A case-control study of EoE patients, ages 6 months to 18 years (between 2018-2021) was performed. Patients were eligible if they had allergy testing, assessment of atopic history, and at least one endoscopy following initiation of treatment. Patients were considered non-atopic if they had negative allergy testing and no history of significant atopy. Response to therapy was classified as complete (peak eos < 15/hpf), partial (≥ 15 eos/hpf but at least a 50% reduction in peak eos), or non-response.
RESULTS: 168 participants were enrolled. The majority were white (n=141, 84%), male (n=124, 74%), and non-Hispanic (n=158, 95%). Mean age at diagnosis was 9.4 years (SD: ± 4.8). 123 participants (73.2%) were atopic and 45 (26.8%) were non-atopic. There was no significant difference between atopic and non-atopic for most demographics or presenting symptoms. Non-atopic participants presented younger than atopic participants (8.14 vs. 9.8 years, p=0.046). Swallowed topical corticosteroids (STC) and food elimination diets (FED) were utilized at a similar rate. There were no differences in treatment response between atopic/non-atopic participants in regards to STC, FED, or STC+FED.
CONCLUSIONS: Atopic status does not significantly impact presentation or response to treatment in pediatric EoE, but a lack of atopy may be a risk for earlier onset of disease.

UNASSIGNED: Dysphagia is a frequent symptom of active eosinophilic esophagitis (EoE), but at times it persists despite attaining histologic healing and lack of fibro-stenotic changes. We aimed to describe the manometric findings in this subset of patients.
UNASSIGNED: A retrospective review of charts between 2013 and 2023 at a tertiary pediatric gastroenterology center, treating roughly 1500 EoE patients per year. We included children with EoE referred to high-resolution impedance manometry (HRIM) for persistent dysphagia despite histologic healing (i.e., <15 eosinophils/high-power field [Eos/hpf]). Data including initial EoE diagnosis, endoscopy reports, esophageal biopsies, treatment regimens, and HRIM were retrospectively collected.
UNASSIGNED: The estimated prevalence of post-remission dysphagia in our cohort was exceedingly rare (<0.05%). Four patients met the eligibility criteria of histologic remission and absence of fibro-stenotic features on endoscopic evaluation and thus, were included in this case series. Patients achieved remission with steroids, proton-pump inhibitor, or both within a median time of 5 months from diagnosis. Peak Eosinophil count at remission was ≤5 Eos/hpf in three patients and ≤10 Eos/hpf in one. On HRIM, all four patients had a hypomotile esophagus and abnormal bolus clearance. Lower esophageal sphincter integrated relaxation pressure values were normal in three patients and elevated in one. Two patients were diagnosed with ineffective esophageal motility, one with aperistalsis and one with achalasia type 1.
UNASSIGNED: Post-remission dysphagia is rare in EoE. Esophageal dysmotility with a hypomotile pattern may contribute to the persistent dysphagia in children with EoE. HRIM should be considered in patients with EoE in whom symptoms persist despite histologic remission.

CONCLUSIONS: Tezepelumab use for asthma successfully induced and sustained eosinophilic esophagitis remission and reversed its pathologic transcriptome. This case provides insight into the mechanistic underpinnings of type 2 inflammation in EoE and the clinical utility of targeting these pathways for treatment.

Food allergies occur due to a lack of tolerance to the proteins found in foods. While IgE- and non-IgE-mediated food allergies have different clinical manifestations, epidemiology, pathophysiology, and management, they share dysregulated T cell responses. Recent studies have shed light on the contributions of different T cell subsets to the development and persistence of different food allergic diseases. This review discusses the role of T cells in both IgE- and non-IgE-mediated food allergies and considers the potential future investigations in this context.

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The present document constitutes Part 2 of the EoETALY Consensus Statements guideline on the diagnosis and management of eosinophilic esophagitis (EoE) developed by experts in the field of EoE across Italy (i.e., EoETALY Consensus Group). Part 1 was published as a different document, and included three chapters discussing 1) definition, epidemiology, and pathogenesis; 2) clinical presentation and natural history and 3) diagnosis of EoE. The present work provides guidelines on the management of EoE in two final chapters: 4) treatment and 5) monitoring and follow-up, and also includes considerations on knowledge gaps and a proposed research agenda for the coming years. The guideline was developed through a Delphi process, with grading of the strength and quality of the evidence of the recommendations performed according to accepted GRADE criteria.This document has received the endorsement of three Italian national societies including the Italian Society of Gastroenterology (SIGE), the Italian Society of Neurogastroenterology and Motility (SINGEM), and the Italian Society of Allergology, Asthma, and Clinical Immunology (SIAAIC). The guidelines also involved the contribution of members of ESEO Italia, the Italian Association of Families Against EoE.

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