Quality Indicators for Eosinophilic Esophagitis Management

Quality Indicators for Eosinophilic Esophagitis Management

Prateek Sharma, MD, FASGE, reviewing Leiman DA, et al. Am J Gastroenterol 2023 Jan 5.

Eosinophilic esophagitis (EoE) is a chronic condition increasingly encountered in clinical practice. The establishment of quality indicators (QIs) in EoE will lead to the standardization of practice and eventually improve patient outcomes. 

In this study, literature review searches and society guidelines were used for the creation of QIs. A total of 29 statements were listed for ranking through a 3-round Delphi process by a panel of 9 experts in the field. During round 1, the experts individually ranked the statements, in round 2 the statements were discussed as a group, and then the statements were reranked in round 3. 

Of the 29 statements, 9 (31%) were agreed upon as highly valid QIs, including statements on tissue sampling, endoscopic assessment, dilation, therapeutic maintenance, disease monitoring, and allergy testing (listed below): 

  • In patients with esophageal dysphagia without a known etiology, a minimum of 6 biopsies from at least 2 esophageal levels should be obtained to assess for EoE.
  • In all patients with food impaction, diagnostic biopsies should be obtained, if medically safe to do so, at the time of endoscopy.
  • In patients with EoE starting an empiric elimination diet, allergy testing is not required to direct therapy.
  • In patients with EoE with persistent symptoms despite histologic response, endoscopic dilation in patients with esophageal stricture should be performed.
  • In patients with EoE requiring endoscopic dilation, all available dilation techniques are acceptable for use.
  • In patients with EoE, biopsies should be obtained to assess histologic response after initiating treatment or with subsequent therapeutic changes. 
  • In patients with EoE undergoing endoscopy, the Eosinophilic Esophagitis Endoscopic Reference Score should be documented.
  • In patients with EoE, maintenance therapy should be continued. 
  • In patients with EoE, routine clinical and endoscopic follow-up should continue after clinicopathologic remission is achieved.

Prateek Sharma, MD, FASGE


Comprehensive quality indicators have been developed by this study’s investigators for gastroenterologists treating patients with EoE. These quality indicators could be used as starting points for the standardization of care when treating EoE.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Leiman DA, Kamal AN, Otaki F, et al. Quality indicators for the diagnosis and management of eosinophilic esophagitis. Am J Gastroenterol 2023 Jan 5. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002138)

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