Perspectives in clinical gastroenterology and hepatology
Diagnosis and Management of Eosinophilic Esophagitis

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Eosinophilic esophagitis (EoE) is a chronic inflammatory condition characterized by esophageal dysfunction and eosinophilic infiltrate in the esophageal epithelium in the absence of other potential causes of eosinophilia. EoE is increasing in incidence and prevalence, and is a major cause of gastrointestinal morbidity among children and adults. EoE is thought to be immune mediated, with food or environmental antigens stimulating a T-helper (Th)-2 inflammatory response. An increased understanding of the pathogenesis of EoE has led to the evolution of diagnostic and treatment paradigms. We review the latest approach to diagnosis of EoE and present consensus diagnostic guidelines. We also discuss the clinical, endoscopic, and histologic features of EoE and challenges to diagnosis. Finally, we present the 3 major treatment options for EoE: pharmacologic therapy, dietary modification, and endoscopic dilation.

Section snippets

Diagnosis of Eosinophilic Esophagitis

The first consensus guidelines for diagnosis of EoE were published in 2007 and represented a major milestone.30 Before this, there was marked variability in the literature with regard to how the disease was defined,31 and after this, there has been some degree of increasing uniformity in diagnosis, although this has not been complete.32, 33 The 2007 guidelines emphasized that EoE was a clinicopathologic condition, meaning that both clinical and histologic features were needed for diagnosis and

Treatment of Eosinophilic Esophagitis

Treatment of EoE is focused on improving both patient symptoms and histology on esophageal biopsies as well as correcting or preventing complications such as esophageal strictures or food impactions leading to esophageal rupture, but there are currently few data to support specific treatment end points.1, 85 Ideally, the goal would be complete symptom resolution and normalization of the esophageal epithelium with elimination of all eosinophils, but in practice, symptom improvement and

Conclusions

During the past 2 decades, EoE has made a remarkable transformation from a rarely seen, case-reportable diagnosis to a commonly encountered condition in gastrointestinal practice. Because no individual clinical, endoscopic, or histologic feature alone is pathognomonic, EoE is a clinicopathologic condition; to diagnose EoE, all features must be considered together. The most recent consensus guidelines state that EoE is diagnosed when there are symptoms of esophageal dysfunction, ≥15 eos/hpf on

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    Conflicts of interest The author discloses no conflicts.

    Funding Supported in part by NIH award number 1K23 DK090073-01.

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