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A common theme apparent in both the guideline and the accompanying technical review includes the need for uniform end points in clinical trials to facilitate meaningful comparisons between therapies

A common theme apparent in both the guideline and the accompanying technical review includes the need for uniform end points in clinical trials to facilitate meaningful comparisons between therapies. food antigen-driven Th2 inflammatory condition, there is a large body of evidence that EoE patients have aeroallergen sensitization and concurrent atopic diseases, including asthma, allergic rhinitis, and eczema. There is a close conversation between these organ-specific diseases and potential for common triggering antigens in EoE and other atopic conditions. A dramatic rise in the recognition of EoE in the United States, first in pediatrics and subsequently in adults, was paralleled by an increase in publications on EoE.1 The past 25 years have witnessed the emergence of the field from small case series and observational studies to larger, international, multicenter, randomized controlled trials (RCTs) of both medical and dietary therapies.2 This guideline provides evidence-based recommendations focusing on the clinical management of EoE for both pediatric and adult allergists and gastroenterologists. Unless specified, the recommendations are applicable to the short-term treatment of EoE, as the current evidence base is usually primarily composed of trials extending from 2 to 16 weeks. With the exception of the recommendation on esophageal dilation, the guidelines are based on the failure to achieve histologic remission of 15 eosinophils/high power field (eos/hpf) as the definition of treatment effect.2 Additional PF 750 relevant outcome metrics, including symptoms and endoscopic features, could not be synthesized due to the use of varying and largely unvalidated instruments, variable study methodology, and a large degree of heterogeneity in reporting of outcomes. In forming the estimate of the effect for observational studies lacking a contemporaneous control group, the 8-week, placebo-controlled arm rate for failing to achieve histologic remission from topical glucocorticosteroid studies (86.7%) was used to allow comparison. In recommendations that this historical control group was used, the quality and strength of PF 750 evidence was downgraded for using this indirect comparator. For these recommendations, risk ratios (RRs) are presented by applying the baseline risk from the untreated control arms from steroid RCTs to the RR. As was reported in the technical review, use of this comparator should not be viewed the same as a direct control group comparison, but PF 750 as an approximated measure that is permissible under Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The guideline was developed utilizing a Ywhaz process outlined elsewhere.3 Briefly, both the AGA and JTF process for developing clinical practice guidelines incorporates GRADE methodology3 and best practices as outlined by the Institute of Medicine.4 GRADE methodology was utilized to prepare the background information for the guideline and the technical review that accompanies it.2 GRADE uses the PICO format, which frames a clinical question by defining a specific population (P), intervention (I), comparator (C), and outcomes (O). The PICO questions focused on the PF 750 use of therapeutics in patients with EoE. Each of the selected PICO questions was addressed in this review using the GRADE framework using evidence profiles, except for the last 2 PICO questions, which were addressed using a GRADE narrative review format. All recommendations were formulated using the GRADE evidence to decision framework (Tables 1C3). Optimal understanding of this guideline will be enhanced by reading applicable portions of the technical review. A unique aspect of this guideline and the corresponding technical review was their development through a collaboration between AGA and JTF, which is composed of the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology. In addition, representatives of both pediatric and adult medicine were included as well as a patient with EoE. This collaborative guideline reflects the interdisciplinary nature of EoE that integrates clinical and investigative efforts of multiple domains and builds on prior consensus recommendations published in both the allergy and gastroenterology literature.5,6 Table 1 GRADE Definitions on.