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
Jenny Epstein, MB ChB MRCPCH PhD
Consultant Paediatric Gastroenterologist
Chelsea and Westminster Hospital
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.
Dr Jenny Epstein wishes to gratefully acknowledge Dr Evan S. Dellon, the previous contributor to this topic.
ESD is an author of a number of references cited in this topic.
David Katzka, MD
Professor of Medicine
DK has served on advisory boards (Adare, Receptos) and received research funding (Covidien).
Alexandra Papadopoulou, MD
Chief of the Division of Gastroenterology and Hepatology
First Department of Pediatrics
University of Athens
Agia Sofia Children’s Hospital
AP has received speaker’s honorariums from Nestle and Nutricia; research grants from Biogaia/Nutricia/Abbvie; consultant’s fee from Receptos.
- 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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