New ACG Guidelines for EoE
The American College of Gastroenterology (ACG) provides evidence-based recommendations for diagnosing and managing gastrointestinal diseases. The 2025 EoE guidelines mark a major shift toward safer, more accessible care.
We fully support the updated ACG guidance and are proud that our innovations align with these evolving standards of care—offering clinicians and patients a more flexible and effective approach to long-term EoE management.
Learn more about ACG GuidelinesKey Highlights – Allergy & Immunology Perspective
Rising Prevalence
EoE prevalence is rising and is considered part of the atopic march, emphasizing the need for allergists to screen for subtle symptoms.
Shared Decision Making
Updated ACG guidelines recommend a shared-decision framework for initial therapy—selecting among proton pump inhibitors, swallowed topical steroids, or empiric elimination diets based on patient preferences.
Simplified Elimination Diets
Less restrictive elimination diets, such as isolated dairy elimination, demonstrate similar efficacy to four- or six-food elimination approaches, improving adherence and quality of life.
Continued Maintenance
Continued maintenance therapy, including dietary or pharmacologic treatments, is essential to prevent recurrence of symptoms, histologic inflammation, and endoscopic findings.
EST (EnteroTracker™)
The esophageal string test (EST, EnteroTracker™) provides a nonendoscopic, in-office monitoring option by measuring eosinophil-associated proteins from a one-hour placed string to generate an EoEScore correlating with biopsy eosinophil counts and endoscopic severity, and is now commercially available for surveillance testing.
Allergy Co-Management
Allergists are uniquely positioned to co-manage EoE by recognizing subtle dysphagia (“IMPACT” behaviors), optimizing allergic comorbidities through targeted testing and therapies, and guiding tailored dietary reintroductions.
Comprehensive Care
Comprehensive, patient-centered care—addressing nutritional management, psychological well-being, and patient education in addition to medical treatment—is key to truly supporting each individual beyond symptom control.
Rising Prevalence
EoE prevalence is rising and is considered part of the atopic march, emphasizing the need for allergists to screen for subtle symptoms.
Shared Decision Making
Updated ACG guidelines recommend a shared-decision framework for initial therapy—selecting among proton pump inhibitors, swallowed topical steroids, or empiric elimination diets based on patient preferences.
Simplified Elimination Diets
Less restrictive elimination diets, such as isolated dairy elimination, demonstrate similar efficacy to four- or six-food elimination approaches, improving adherence and quality of life.
Conclusion
Incorporating the Esophageal String Test® into routine practice enables minimally-invasive, in-office disease monitoring—reducing reliance on endoscopy, enhancing patient comfort, and empowering allergists to deliver comprehensive, tailored care for better long-term outcomes.