European Guidelines on Eosinophilic Esophagitis: Evidence‐Based Statements and Recommendations for Diagnosis and Management in Children and Adults. Part 1: Diagnosis, Epidemiology and Natural History

INTRODUCTION: Eosinophilic esophagitis (EoE) has evolved from a rare condition to the leading cause of dysphagia and food impaction. This document (Part 1) provides an updated evidence-based framework for the definition, epidemiology, natural history, and diagnosis of EoE in children and adults, updating the 2017 European evidence-based guidelines. METHODS: A panel of 32 experts from EUREOS, EAACI, ESPGHAN, and ESP developed these guidelines. Comprehensive literature searches were conducted (PubMed, Scopus, Embase, and Google Scholar) using the PICO framework. The GRADE methodology was applied to assess the certainty of evidence and strength of recommendations, while consensus was established via the Delphi method, requiring a minimum agreement threshold of 80%. RESULTS: These guidelines characterize EoE as a heterogeneous condition driven by type 2 inflammation, with natural history influenced by diverse phenotypes and progression risks. EoE burden has risen sharply, with an annual incidence exceeding 10/100,000 and a pooled prevalence over 60/100,000, surpassing 160/100,000 in some regions. Diagnosis requires both symptoms of esophageal dysfunction and ≥ 15 eosinophils/hpf in esophageal mucosa, following the exclusion of alternative causes. EoE is clearly distinguished from asymptomatic esophageal eosinophilia. Key diagnostic recommendations include obtaining at least six biopsies from at least two esophageal levels, as endoscopic appearance alone lacks sufficient sensitivity. Gastric or duodenal biopsies are no longer mandatory unless driven by specific symptoms or endoscopic abnormalities at any point. CONCLUSIONS: These guidelines provide a robust clinical framework that reflects the increasing global prevalence of EoE and standardizes diagnostic criteria across all age groups to improve patient management.

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Journal
Allergy
Published
2026-10-26
DOI
https://doi.org/10.1111/all.70545
Primary Topic
Eosinophilic Esophagitis
Type
article
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article

European Guidelines on Eosinophilic Esophagitis: Evidence‐Based Statements and Recommendations for Diagnosis and Management in Children and Adults. Part 1: Diagnosis, Epidemiology and Natural History

Marie Carlson, Alex Straumann, Cecílio Santander, Danila Guagnozzi et al.
Allergy
Eosinophilic Esophagitis
article

European Guidelines on Eosinophilic Esophagitis: Evidence‐Based Statements and Recommendations for Diagnosis and Management in Children and Adults. Part 1: Diagnosis, Epidemiology and Natural History

Marie Carlson, Alex Straumann, Cecílio Santander, Danila Guagnozzi, Cord Langner, Alain M. Schoepfer, Henrik Bergquist, Jorge Amil Dias, Thomas Eiwegger, Antonio Tejera‐Muñoz, Jesús González‐Cervera, Martin Storr, Ulrike von Arnim, Javier Chahuán A., Helen M. Larsson, Albert Jan Bredenoord, Luc Biedermann, Sara Feo‐Ortega, Noam Zevit, Alexandra Papadopoulou, Christoph Schlag, Anne Lund Krarup, Alfredo José Lucendo, Thomas Greuter, Matteo Ghisa, Stephen Attwood, Edoardo Vincenzo Savarino, Salvatore Oliva, Francesca Racca, Carolina Gutiérrez‐Junquera, Ángel Arias, Javier Molina‐Infante, Lucía Gutiérrez‐Ramírez, Sandra López García-Dionisio
article en

Abstract

INTRODUCTION: Eosinophilic esophagitis (EoE) has evolved from a rare condition to the leading cause of dysphagia and food impaction. This document (Part 1) provides an updated evidence-based framework for the definition, epidemiology, natural history, and diagnosis of EoE in children and adults, updating the 2017 European evidence-based guidelines. METHODS: A panel of 32 experts from EUREOS, EAACI, ESPGHAN, and ESP developed these guidelines. Comprehensive literature searches were conducted (PubMed, Scopus, Embase, and Google Scholar) using the PICO framework. The GRADE methodology was applied to assess the certainty of evidence and strength of recommendations, while consensus was established via the Delphi method, requiring a minimum agreement threshold of 80%. RESULTS: These guidelines characterize EoE as a heterogeneous condition driven by type 2 inflammation, with natural history influenced by diverse phenotypes and progression risks. EoE burden has risen sharply, with an annual incidence exceeding 10/100,000 and a pooled prevalence over 60/100,000, surpassing 160/100,000 in some regions. Diagnosis requires both symptoms of esophageal dysfunction and ≥ 15 eosinophils/hpf in esophageal mucosa, following the exclusion of alternative causes. EoE is clearly distinguished from asymptomatic esophageal eosinophilia. Key diagnostic recommendations include obtaining at least six biopsies from at least two esophageal levels, as endoscopic appearance alone lacks sufficient sensitivity. Gastric or duodenal biopsies are no longer mandatory unless driven by specific symptoms or endoscopic abnormalities at any point. CONCLUSIONS: These guidelines provide a robust clinical framework that reflects the increasing global prevalence of EoE and standardizes diagnostic criteria across all age groups to improve patient management.

Allergy
Uppsala University (SE), University of Padua (IT), Pontificia Universidad Católica de Chile (CL), Tel Aviv University (IL), University of Toronto (CA), Durham University (GB), Medical University of Graz (AT), Aalborg University Hospital (DK), Hospital for Sick Children (CA), Centre Hospitalier Universitaire Vaudois (CH), University Hospital of Zurich (CH), Starnberg Hospital (DE), Vall d'Hebron Institut de Recerca (ES), NU Hospital Group (SE), Hospital Universitario Puerta de Hierro Majadahonda (ES), Schneider Children's Medical Center (IL), Hospital General de Tomelloso (ES), Universitätsklinikum St. Pölten (AT), Humanitas Gavazzeni (IT), Vall d'Hebron Hospital Universitari (ES), Hospital Universitario de La Princesa (ES), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), Azienda Ospedale - Università Padova (IT), Karl Landsteiner University of Health Sciences (AT), Amsterdam University Medical Centers (NL), Complejo Hospitalario de Cáceres (ES), Iaso Children’s Hospital (GR), Complejo Hospitalario Universitario de Toledo (ES), Center for Security Studies (GR), Hospital Lusíadas Porto (PT), Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (ES), Keele University (GB), Università della Svizzera italiana (CH), Camilo José Cela University (ES), Universidad Autónoma de Madrid (ES), Sapienza University of Rome (IT), University of Gothenburg (SE), Aalborg University (DK), Otto-von-Guericke-Universität Magdeburg (DE), University of Lausanne (CH)
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Eosinophilic Esophagitis
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