Theme | The BSPGHAN EoE WG recommends that: | Voting consensus (%) |
1 | STS are indicated in: | |
Induction therapy | 100 | |
Maintenance therapy | 100 | |
First-line treatment of EoE | 92 | |
Combination therapy with PPI | 83 | |
Second-line treatment after unsuccessful responses to dietary therapy and/or PPI | 100 | |
Oesophageal stricture treatment in isolation or as an adjunct to oesophageal balloon dilatation | 92 | |
2 | The type of STS preparation offered should take into consideration the child’s age, palatability, chance of adherence, comorbidities and family support | 100 |
If a child is assessed to be able to tolerate and coordinate orodispersible budesonide (tablet) preparation and it is locally available, then this preparation should be first choice. | 92 | |
3 | Age should be used to determine STS dosing unless a child significantly deviates from their growth centiles, in which case height should be accounted for. | 100 |
4 | Twice daily dosing is considered for induction therapy. | 100 |
For children <10 years old, a dose of 0.5 mg two times per day should be used (1 mg/day), for children ≥10 years old, a dose of 1 mg two times per day should be used (2 mg/day). | 100 | |
Induction therapy should be usually given for a minimum of 3 months. | 100 | |
5 | After histological remission has been achieved, maintenance therapy should be considered for a minimum of 1–2 years. | 100 |
For children <10 years old, a dose of 0.5 mg/day should be used, for children ≥10 years old, a dose of 1 mg/day should be used. | 100 | |
6 | After confirmed histological remission and 3-month induction therapy, clinicians should consider halving the STS dose. | 100 |
During maintenance therapy, dose weaning should be considered every 6–12 months. | 92 | |
Oral or oesophageal candidiasis does not usually require stopping the STS; antifungal treatment should be added alongside the STS. | 83 | |
7 | Endoscopy | |
Should be repeated during the induction period to ensure histological response to STS and allow weaning of the medication. | 92 | |
Should be repeated if there is worsening of symptoms/oesophageal dysfunction. | 100 | |
Surveillance should be considered at 1–2 yearly intervals or if considering stopping treatment or following cessation of therapy if clinically indicated. | 100 |
BSPGHAN EO WG, British Society of Paediatric Gastroenterology, Hepatology and Nutrition Eosinophilic Oesophagitis Working Group; PPI, proton pump inhibitor; STS, swallowed topical steroid.