ASGE Recognized Industry Associate (ARIA) Training Program for Regeneron and Sanofi | June 2023-Epidemiology and Diagnosis of EoE

Pdf Summary

Eosinophilic Esophagitis (EoE) is a chronic immune-mediated disease driven by food antigens. It is characterized by symptoms related to esophageal dysfunction and the presence of eosinophil-predominant inflammation in biopsy specimens. A minimum threshold of 15 eosinophils per high-power field (hpf) is required for a diagnosis. EoE is isolated to the esophagus and other causes of eosinophilia must be ruled out. <br /><br />Historically, EoE was first described in case reports and series in the late 1970s and early 1980s. Consensus guidelines were established in 2007 and updated in 2011 and 2013. EoE is associated with other atopic diseases, with 78% of patients having more than one atopic condition. <br /><br />The prevalence of EoE varies, with estimates ranging from 34 per 100,000 to 104 per 100,000 in different populations. The condition is more common in males, with a male-to-female ratio of 3:1. It is found in 2-7% of patients undergoing endoscopy for any reason and in 12-23% of patients undergoing endoscopy for dysphagia. <br /><br />The pathophysiology of EoE involves the recruitment of eosinophils from the bone marrow in response to food and environmental allergens. Eosinophils and mast cells promote tissue remodeling and inflammation by secreting inflammatory proteases, cytokines, and histamines.<br /><br />Clinical presentation of EoE includes dysphagia, food impaction, reflux, vomiting, abdominal pain, and failure to thrive in children. Diagnosis is confirmed through endoscopy, where distinctive endoscopic features such as edema, rings, exudates, furrows, and strictures can be observed. Histologic analysis of biopsy samples reveals superficial layering, eosinophilic microabscess, spongiosis, epithelial hyperplasia, degranulation, and lamina propria fibrosis. <br /><br />The natural history of EoE involves a progressive increase in fibrosis over time, which can lead to complications such as strictures. Diagnostic delay is associated with a higher prevalence of fibrotic features and an increased risk of stricture formation. Therefore, early diagnosis and treatment are important.

Asset Subtitle

Nirmala Gonsalves, MD

Keywords

Eosinophilic Esophagitis

chronic immune-mediated disease

food antigens

esophageal dysfunction

eosinophil-predominant inflammation

diagnosis criteria

atopic diseases

prevalence

pathophysiology

clinical presentation