Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition where infiltration of eosinophils into the esophageal mucosa leads to symptoms of esophageal dysfunction. It has rapidly emerged as an important cause of upper GI morbidity in patients of all ages and is encountered in a substantial proportion of patients undergoing diagnostic upper endoscopy. This review discusses the clinical, endoscopic, and histologic features of EoE and presents the most recent guidelines for diagnosis of EoE. It describes selected diagnostic dilemmas including distinguishing EoE from gastroesophageal reflux disease and addressing the newly recognized clinical entity of proton pump inhibitor responsive esophageal eosinophilia. It also highlights evidence to support both pharmacologic and non-pharmacologic treatments, including topical corticosteroids, dietary elimination therapy, and endoscopic dilation.

Eosinophilic oesophagitis – symptoms, diagnosis and treatment

“…The diagnostic process begins with a thorough medical history taking, aimed at identifying the presence of characteristic symptoms, which often depend on the patient's age (1,19) . The coexistence of atopic diseases, including family members, is also important.…”

“…The coexistence of atopic diseases, including family members, is also important. Additionally, patients with positive family history for EoE have an increased risk of the disorder (19) . The next step is to perform endoscopy and collect specimens from the oesophageal mucosa for histopathology.…”

“…The next step is to perform endoscopy and collect specimens from the oesophageal mucosa for histopathology. Endoscopy and biopsy are the gold diagnostic standard and the only reliable method of monitoring the therapeutic efficacy (1,(19)(20)(21) . Exclusion of other potential causes of the presence of eosinophils in the oesophageal mucosa is an essential element of the differential diagnosis.…”

“…18 No. 4, p. 307-312 syndrome, fungal or viral oesophageal infections, oesophageal Crohn's disease, cardia achalasia and graft vs. host disease (GvHD) (19,22) . A method of endoscopic assessment of EoE lesions (Endoscopic Reference Score, EREFS) was developed and validated in 2012.…”

“…The first sign indicates a high fragility of the mucosa, which is damaged when the endoscope is moved around the strictures, and the second refers to the need to use greater force when collecting mucosal biopsy specimens with biopsy forceps, which results from subepithelial fibrosis. Both symptoms were excluded from EREFS due to their insufficient sensitivity and specificity (19,20) . Particular attention should be paid to the differences in the endoscopic picture of EoE depending on the patient's age.…”