Introduction:

Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by esophageal dysfunction, which may progress to fibrosis or stricture formation without appropriate treatment.

Objective:

To develop evidence-based recommendations through expert consensus for the diagnosis of EoE in individuals younger than 18 years.

Methods:

A multidisciplinary panel of 16 national experts from COLGAHNP-including allergists, pathologists, and adult gastroenterologists-together with four international specialists, formulated 18 clinical questions (8 related to diagnosis and 10 to treatment). A literature search was conducted analyzing clinical practice guidelines, randomized clinical trials, and systematic reviews published over the past decade. Twenty-seven recommendations were developed (12 for diagnosis and 15 for treatment) and submitted for voting using a modified Delphi method across two rounds. The project was sponsored by COLGAHNP.

Results:

All recommendations achieved >90% agreement. EoE should be suspected in patients presenting with esophageal dysfunction and personal or family history of allergic disease. Endoscopy may or may not reveal inflammatory or fibrotic changes (EREFS). At least six esophageal biopsies should be obtained, in addition to initial gastric and duodenal biopsies, given the potential coexistence of other eosinophilic gastrointestinal disorders. Histology typically demonstrates eosinophilic infiltration (≥15 eosinophils per high-power field). Allergy testing should not be routinely used to identify EoE-triggering allergens. A barium esophagram is more sensitive than endoscopy for detecting narrowing or strictures. pH-impedance monitoring, transnasal endoscopy, high-resolution manometry, EndoFLIP, and endoscopic ultrasound have specific indications.

Conclusion:

This consensus provides evidence-based diagnostic recommendations for EoE tailored to patients, families, and healthcare decision-makers within the Colombian and Latin American context.

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