Eosinophilic esophagitis

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Última revisão: 11 Dec 2025

Última atualização: 16 Dec 2025

Eosinophilic esophagitis (EoE) is a chronic immune-mediated/allergen-mediated condition characterized by infiltration of eosinophils in the esophageal mucosa.

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.

Pharmacotherapy (topical corticosteroids, proton-pump inhibitors [PPIs], or dupilumab) or dietary elimination can be used as a first-line treatment. Endoscopic dilation is 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.

Definição

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.[1][2][3] To account for the increasing use of digital optical microscopy, the joint consensus guidelines from the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition recommend using an updated peak eosinophil count of ≥15 per 0.3 mm².[2] The condition is also abbreviated to EoO.

História e exame físico

Principais fatores diagnósticos

dysphagia
food avoidance and modification behaviors

Detalhes completos

Outros fatores diagnósticos

heartburn
chest discomfort
nausea/vomiting
regurgitation
abdominal pain
failure to thrive
irritability

Detalhes completos

Fatores de risco

family history of eosinophilic esophagitis (EoE)
male sex
atopic disease
children and younger adults
white ancestry

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

esophagogastroduodenoscopy
esophageal biopsy
CBC with differential

Detalhes completos

Investigações a serem consideradas

barium swallow (esophagram)

Detalhes completos

Novos exames

unsedated transnasal endoscopy
esophageal string test
cytosponge
esophageal physiological testing
eosinophilic esophagitis (EoE) diagnostic panel

Algoritmo de tratamento

AGUDA

at initial diagnosis

CONTÍNUA

response to initial therapy

nonresponse or relapse

Colaboradores

Autores

Jenny Epstein, MB ChB MRCPCH PhD

Consultant Paediatric Gastroenterologist

Chelsea and Westminster Hospital

London

Declarações

JE is a member of the advisory board for Dr Falk Pharma, manufacturer of Jorveza, a new formulation of budesonide licensed for adults with eosinophilic esophagitis (EoE), and Nurtricia for infant functional bowel disorders. She has received honoraria from Dr Falk Pharma to speak on EoE and has been sponsored by Dr Falk Pharma, Abbvie and Nutricia to attend national and international meetings. JE is a member of BSPGHAN IBD working group, medical advisor to CICRA and Coeliac UK, member of CCUK IBD working group, member of BSG EoE Guideline development group, member of NICE Guideline update committee for Crohn disease and ulcerative colitis, member of NICE Diagnostics, and sits on the NICE advisory committee for personalized treatment in Crohn disease.

Agradecimentos

We would like to acknowledge our Gastroenterology expert panel member, Dr Brooks D.Cash, for his contribution to this topic. Dr Jenny Epstein wishes to gratefully acknowledge Dr Evan S. Dellon, the previous contributor to this topic.

Declarações

BDC declares that he has no competing interests. ESD is an author of a number of references cited in this topic.

Revisores

David Katzka, MD

Professor of Medicine

Mayo Clinic

Rochester

Declarações

DK has served on advisory boards (Adare, Receptos) and received research funding (Covidien).

Alexandra Papadopoulou, MD

Honorary Professor

Chief of the Division of Gastroenterology and Hepatology

First Department of Pediatrics

University of Athens

Agia Sofia Children’s Hospital

Athens

Greece

Declarações

AP has received speaker’s honorariums from Nestle and Nutricia; research grants from Biogaia/Nutricia/Abbvie; consultant’s fee from Receptos.

Créditos aos pareceristas

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Referências

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Principais artigos

Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459-87.Texto completo Resumo

Dellon ES, Muir AB, Katzka DA, et al. ACG clinical guideline: diagnosis and management of eosinophilic esophagitis. Am J Gastroenterol. 2025 Jan 1;120(1):31-59.Texto completo Resumo

Amil-Dias J, Oliva S, Papadopoulou A, et al. Diagnosis and management of eosinophilic esophagitis in children: an update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024 Aug;79(2):394-437.Texto completo Resumo

Hirano I, Chan ES, Rank MA, et al. AGA institute and the joint task force on allergy-immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2020 May;124(5):416-23.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Gastroesophageal reflux disease (GERD)
- Eosinophilic gastroenteritis
- Achalasia
Mais Diagnósticos diferenciais
Guidelines
- Diagnosis and management of eosinophilic esophagitis
- Diagnosis and management of eosinophilic esophagitis in children
Mais Guidelines
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Eosinophilic esophagitis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

at initial diagnosis

response to initial therapy

nonresponse or relapse

Colaboradores

Autores

Jenny Epstein, MB ChB MRCPCH PhD

Declarações

Agradecimentos

Declarações

Revisores

David Katzka, MD

Declarações

Alexandra Papadopoulou, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Guidelines

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Log in or subscribe to access all of BMJ Best Practice

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