EoE Module 14 References-Dellon Curr Opin Gastroenterol 2012 Eosinophilic esophagitis Diagnostic tests and criteria

Dellon Curr Opin Gastroenterol 2012 Eosinophilic esophagitis Diagnostic tests and criteria

Pdf Summary

Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disorder, increasingly recognized in both children and adults. It is characterized by symptoms such as esophageal dysfunction, dysphagia, and food impaction. Diagnosis is challenging due to the overlap of EoE symptoms with other conditions like gastroesophageal reflux disease (GERD).<br /><br />To diagnose EoE, three criteria must be met: clinical symptoms of esophageal dysfunction, esophageal biopsy with at least 15 eosinophils per high-power microscopy field, and exclusion of other causes of esophageal eosinophilia, such as GERD and proton-pump inhibitor responsive esophageal eosinophilia (PPI-REE). Endoscopy is essential for evaluating esophageal changes and obtaining biopsies, as up to 20% of EoE patients have a normal appearing esophagus during endoscopy. <br /><br />Histologically, EoE is marked by an eosinophilic infiltrate throughout the esophagus, formation of eosinophilic microabscesses, basal zone hypertrophy, and often, tissue fibrosis in the lamina propria. The relationship between EoE and GERD is complicated as symptoms and findings can overlap, and patients can exhibit a newly recognized phenotype, PPI-REE, where symptoms and esophageal eosinophilia respond to PPI treatment. <br /><br />Updated guidelines emphasize a comprehensive approach combining clinical, endoscopic, and histological data. Future diagnostic methods may include the use of symptom scores, improved imaging techniques, and biomarker development, potentially streamlining the diagnostic process. Currently, after ruling out other conditions with a PPI trial, persistent eosinophilia on biopsy confirms EoE, distinguishing it from GERD or PPI-REE. Nonetheless, as knowledge and technology evolve, diagnostic criteria and methods for EoE are expected to advance significantly.

Keywords

Eosinophilic esophagitis

Chronic immune-mediated disorder

Esophageal dysfunction

Dysphagia

Food impaction

GERD

Esophageal biopsy

Endoscopy

Eosinophilic infiltrate

PPI-REE