Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-The Eosinophilic Attack

Video Transcription

Video Summary

The presentation focuses on eosinophilic esophagitis (EOE), a chronic esophageal disease characterized by elevated eosinophils in the esophagus, requiring both clinical and histologic criteria for diagnosis. The pathophysiology involves genetic predispositions (notably CALPANE-14, TSLP, STAT6), early life exposures, and complex immune responses, including Th2 activation, leading to eosinophil infiltration and potential fibrosis. Histologically, diagnosis hinges on identifying ≥15 eosinophils per high power field, basal cell hyperplasia, spongiosis (expanded intracellular spaces), eosinophilic microabscesses, and subepithelial fibrosis. Distinguishing EOE from reflux esophagitis is challenging due to overlapping features like eosinophil counts and basal hyperplasia; clinical correlation and multiple biopsies are essential. Treatment effects on biopsies can show complete remission, partial response, or disease progression with increasing fibrosis. The disease often shows patchy distribution, so multiple biopsies (6-9) improve diagnostic sensitivity to nearly 100%. Active collaboration between pathologists and clinicians, including sharing patient history and prior biopsy results, is critical for accurate diagnosis and monitoring of EOE.

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Safia Salaria, MD, MMHC

Keywords

eosinophilic esophagitis

eosinophils

Th2 activation

histologic diagnosis

basal cell hyperplasia

subepithelial fibrosis

multiple biopsies