We recommend that EoE is diagnosed based on the presence of symptoms of esophageal dysfunction and at least 15 eos/hpf on esophageal biopsy, after evaluating for non-EoE disorders that cause or potentially contribute to esophageal eosinophilia.

We recommend using a systematic endoscopic scoring system (e.g., the EoE Endoscopic Reference Score) to characterize endoscopic findings of EoE at every endoscopy.

We recommend obtaining at least 6 esophageal biopsies from at least 2 esophageal levels (e.g., proximal/ mid and distal), targeting EoE endoscopic findings, if possible, to assess for histologic features consistent with EoE.

We recommend that eosinophil counts be quantified on esophageal biopsies from every endoscopy performed for EoE.

We suggest PPIs as a treatment for EoE.

We recommend the use of swallowed topical steroids as a treatment for EoE.

We suggest the use of either fluticasone propionate or budesonide in patients with EoE being treated with topical steroids.

We suggest an empiric food elimination diet as a treatment for EoE.

We do not suggest currently available allergy testing to direct food elimination diets for treatment of EoE.

We suggest dupilumab as a treatment for EoE in individuals 12 years of age or older who are nonresponsive to PPI therapy.

We suggest dupilumab as a treatment for EoE in pediatric patients (ages 1–11 years) who are nonresponsive to PPI therapy.

We cannot make a recommendation for or against cendakimab, benralizumab, lirentelimab, mepolizumab, or reslizumab as a treatment for EoE.

We suggest against using omalizumab as a treatment for EoE.

We suggest against the use of cromolyn and montelukast as a treatment for EoE.

We suggest the use of endoscopic dilation as an adjunct to medical therapy as a treatment for esophageal strictures causing dysphagia in patients with EoE.

We suggest continuation of effective dietary or pharmacologic therapy for EoE to prevent recurrence of symptoms, histologic inflammation, and endoscopic abnormalities.

We recommend evaluating response to treatment of EoE with assessment of symptomatic and endoscopic and histologic outcomes.

In children with EoE and dysphagia, we suggest an esophagram for evaluation of fibrostenotic disease.

We suggest evaluation by a feeding therapist and/or dietician as an adjunctive therapeutic intervention in children with EoE and feeding dysfunction.