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

The Eosinophilic Attack

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This presentation by Dr. Safia N. Salaria outlines the pathology, diagnosis, and clinical aspects of eosinophilic esophagitis (EoE), a chronic immune-mediated esophageal disease characterized by esophageal dysfunction symptoms and predominant eosinophilic inflammation histologically. EoE primarily affects males aged 30-44, with associations to atopic conditions including food allergy, asthma, eczema, and allergic rhinitis. Genetic factors implicated include CAPN14, TSLP, LRRC32/EMSY1, and STAT6, with early-life exposures like antibiotic use, cesarean delivery, and preterm birth also playing roles. The esophageal epithelium's mucosal barrier function is significant in disease pathophysiology.<br /><br />Diagnosis requires clinical correlation, including atopic history and characteristic endoscopic features such as esophageal rings, furrows, strictures, edema, and exudates. Histologically, the key criterion is ≥15 eosinophils per high power field isolated to the esophagus. Other microscopic features include eosinophilic microabscesses, basal cell hyperplasia, papillary elongation, vascular dilation, and spongiosis.<br /><br />Challenges in diagnosis arise from symptom variability, tissue sampling heterogeneity, incomplete disease activity measurement, and overlapping features with reflux esophagitis (GERD). Differentiation from reflux esophagitis is critical, as GERD often presents with heartburn and shows different endoscopic and histologic features.<br /><br />Treatment effects on histology vary from complete remission to intermediate changes or disease progression. Accurate diagnosis depends on integrating histologic features, clinical history, endoscopic findings, and response to treatment, with multiple biopsy samples enhancing diagnostic sensitivity due to EoE’s patchy nature.<br /><br />In summary, diagnosing EoE requires comprehensive clinicopathologic assessment, awareness of confounding factors, and careful monitoring of treatment effects to manage this chronic allergic esophageal disorder effectively.

Keywords

Eosinophilic esophagitis

EoE

Chronic immune-mediated esophageal disease

Eosinophilic inflammation

Atopic conditions

Genetic factors in EoE

Esophageal epithelium mucosal barrier

Diagnosis of EoE

Endoscopic features

Histologic criteria