Part 1: Diagnosing EoE: From Symptoms to Histology

Video Transcription

Video Summary

This webinar, part 1 of ASGE’s EOE for APPs series, focused on diagnosing eosinophilic esophagitis (EOE) from symptoms to histology. Presenters reviewed EOE as a chronic, immune-mediated esophageal disease characterized by symptoms of esophageal dysfunction and biopsy findings of at least 15 eosinophils per high-power field, after excluding other causes.<br /><br />The session highlighted the rising global prevalence of EOE, with higher rates in industrialized countries and a strong association with atopy, allergies, asthma, and family history. EOE often presents differently by age: infants and children may have feeding difficulty, vomiting, or poor growth, while adults commonly present with dysphagia, food impaction, chest pain, or refractory heartburn. Diagnostic delay was emphasized as a major concern because untreated disease can progress from inflammation to fibrosis, strictures, and irreversible fibrostenosis.<br /><br />The presenters reviewed when to suspect EOE in clinic, including compensatory eating behaviors like excessive chewing, cutting food into tiny pieces, drinking lots of water with meals, prolonged meal times, and avoidance of meats or bread. Endoscopic findings were discussed using the EREF score: edema, rings, exudates, furrows, and strictures. They stressed that a normal-appearing esophagus does not rule out EOE and that biopsies are essential even when endoscopy looks normal.<br /><br />Histology, biopsy protocol, and differential diagnosis were also covered, including GERD, eosinophilic GI disorders, celiac disease, infection, and pill esophagitis. The session concluded with a Q&A and a reminder about part 2 of the series on therapy.

Keywords

eosinophilic esophagitis

EOE diagnosis

esophageal dysfunction

biopsy histology

eosinophils per high-power field

atopy and allergies

dysphagia

food impaction

EREF score

endoscopic findings

fibrostenosis