In the future, precision medicine may be able to specifically target different therapeutic regimens based on different clinical, endoscopic, and histologic characteristics of EoE; some of this work can be informed by the EoE endotypes recently described. The diagnosis of EoE is made based on symptoms, endoscopic features, and histological findings and EGD with biopsies is considered the diagnostic test of choice. Common endoscopic features include mucosal edema, loss of vascular pattern, linear furrows, white specks, and concentric rings.
Since the esophageal mucosa may appear normal in some patients, it is imperative that esophageal mucosal biopsies be obtained in all cases as diagnosis may otherwise be missed. Due to the patchy nature of EoE, it is recommended to obtain multiple biopsies from proximal and distal esophagus.
It is important to consider other conditions, such as gastroesophageal reflux, that can lead to esophageal eosinophilia. Laboratory and radiologic tests tend to be of limited utility in evaluation of patients with EoE.
Contrast studies of the upper GI tract are not sensitive enough to detect subtle changes of EoE but can help identify alternate pathology or complications of EoE such as esophageal stricture and small-caliber esophagus. Due to invasive nature of EGD required for diagnosis and disease monitoring, there is a quest for finding noninvasive biomarkers and office-based minimally invasive tests.
While several biomarkers such as eosinophil granule proteins and eosinophilic surface and intracellular markers have been investigated, the data are limited and various variables including concomitant atopy needs to be accounted for. In a proof of concept study, urine 3-Bromotyrosine 3-BT differed between EoE and atopic and non-atopic controls. Unsedated in-office transnasal endoscopy may provide another less invasive method for disease monitoring.
Treatment of EoE consists of dietary, pharmacological, and endoscopic interventions Fig. Dietary modification is an effective treatment in a significant number of patients with EoE.
Three dietary methods have gained widespread acceptance: 1 empiric elimination diet: this is based on empiric elimination of most common allergens. Four-food elimination is a commonly used approach in which dairy, soy, wheat, and eggs are empirically eliminated. Compliance and nutritional deficiencies associated with these dietary approaches can be a challenge and a close follow-up with an experienced dietician is important. In addition to acid suppression properties, PPIs have anti-inflammatory properties that impact pathobiology of EoE.
Recently revised guidelines no longer mandate such trial prior to establishing EoE diagnosis but rather position PPI as a treatment modality for EoE. Topical glucocorticoids TCS including budesonide and fluticasone are other pharmacological options and both are effective at improving symptoms and histology in patients with EoE. A variety of administration methods have been used to deliver these drugs including as viscous slurry, metered-dose inhaler, and effervescent tablet.
Possible adverse effects of topical corticosteroid preparations include local candidal overgrowth, adrenal axis suppression and suppression of height velocity. Role of endoscopy in the treatment of EoE is generally limited to management of complications such as food impaction removal or dilation of esophageal strictures that are unresponsive to medical therapy. Relapse is relatively common after dilation, especially if dilation was used as the sole modality for treatment.
Multiple topical corticosteroid preparations, including viscous budesonide suspension and dissolving fluticasone tablets, are being studied in EoE to help with easier administration of medication. There is no clear consensus regarding appropriate maintenance regimen for EoE, a chronic condition that frequently recurs in patient who discontinue treatment. It is generally necessary to continue maintenance treatment, whether avoidance of dietary triggers or pharmacological, to maintain remission.
Knowledge on the natural history of EoE is limited and many aspects including risk-stratification for complications are incompletely defined. There, however, is data to support that chronic, unresolved inflammation results in structural damage to esophagus, leading to fibrosis, strictures, and impaired esophageal function over time. This underscores the importance of early diagnosis and need for maintenance therapy.
EoE is an entity that was largely unknown until about 2—3 decades ago; hence, our understanding of various aspects of its natural history is still in its infancy. More prospective, long-term outcome-based research studies are required to understand these aspects.
This content does not have an Arabic version. Overview Eosinophilic esophagitis Open pop-up dialog box Close. Eosinophilic esophagitis Esophagitis is inflammation that damages the lining of the esophagus. Email address. First Name let us know your preferred name.
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Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Surdea-Blaga T, et al. Eosinophilic esophagitis: Diagnosis and current management. Journal of Gastrointestinal and Liver Diseases.
Spechler SJ. Eosinophilic esophagitis: Novel concepts regarding pathogenesis and clinical manifestations. Journal of Gastroenterology. EoE affects people of all ages and ethnic backgrounds. While both males and females may be affected, a higher incidence is seen in males. Certain families may have an inherited tendency to develop EoE. How is eosinophilic esophagitis diagnosed? A gastroenterologist must evaluate a patient for the symptoms consistent with eosinophilic esophagitis, taking a careful history.
Since EoE can mimic other conditions, more common diseases such as gastroesophageal reflux disease GERD must first be ruled out. A doctor will perform an upper endoscopy.
During this procedure, the patient is sedated or put under anesthesia, and a small tube called an endoscope is inserted through the mouth.
The esophagus, stomach, and the first part of the small intestine are examined for tissue injury, inflammation and thickening of the esophageal wall. Small tissue samples are taken biopsy. This procedure is typically not uncomfortable and may be done on an outpatient basis. A pathologist will analyze the tissue samples under a high-powered microscope to see the small cell structures. If eosinophils are present in the sample, the pathologist will count how many are visible. A count of 15 or more eosinophils per high-powered microscopic field is highly suggestive of EoE.
This causes damage and inflammation, which can cause pain and may lead to trouble swallowing and food getting stuck in your throat. EoE is rare. But because it is a newly recognized disease, more people are now getting diagnosed with it. Researchers are not certain about the exact cause of EoE. Certain genes may also play a role in EoE. There is no cure for EoE.
Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet. Which treatment your health care provider suggests depends on different factors, including your age.
Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it. If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow. The information on this site should not be used as a substitute for professional medical care or advice.
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