Eosinophilic esophagitis (EoE) is a chronic immune-mediated/allergen-mediated condition defined clinically by symptoms of esophageal dysfunction, and pathologically by an eosinophilic infiltration of the esophageal epithelium in the absence of secondary causes of local or systemic eosinophilia.
To consider the diagnosis, there must be an esophageal epithelial infiltrate of ≥15 eosinophils per high-power microscopy field on esophageal biopsy.
Incidence and prevalence are increasing at a rate that is outpacing increased recognition and diagnosis; it is more commonly seen in children and young adults.
Medications (usually topical/swallowed corticosteroids) or dietary elimination can be used as a first-line treatment, with endoscopic dilation reserved for patients with esophageal strictures or fibrostenotic complications.
Prognosis is good, with the majority of patients having a good response to either pharmacologic or dietary elimination therapy.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated/allergen-mediated clinicopathologic condition. It is characterized clinically by symptoms of esophageal dysfunction (e.g., dysphagia and food impaction in adolescents and adults, and vomiting, regurgitation, heartburn, abdominal pain, failure to thrive, or feeding intolerance in children), and histologically by an eosinophilic infiltration of the esophageal epithelium of ≥15 eosinophils per high-power microscopy field in the absence of other causes of local or systemic eosinophilia.
History and exam
Key diagnostic factors
- food avoidance and modification behaviors
Other diagnostic factors
- chest discomfort
- abdominal pain
- failure to thrive
- family history of EoE
- male sex
- atopic disease
- children and younger adults
- white ancestry
1st investigations to order
- esophageal biopsy
- CBC with differential
- transnasal endoscopy
- esophageal string test
- mucosal impedance
- EoE diagnostic panel
at initial diagnosis
response to initial therapy
nonresponse or relapse
- Gastroesophageal reflux disease (GERD)
- Eosinophilic gastroenteritis
- Guideline on informed consent for GI endoscopic procedures
- Clinical guidelines for the management of eosinophilic esophagitis
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