Identifying and Diagnosing EoE

Clinical manifestations of EoE, which are largely attributed to esophageal dysfunction from epithelial remodeling, can be non-specific and may vary depending on several factors, including endotype, duration of disease, and patient age.⁴ Symptoms in pediatric patients include nausea, vomiting and abdominal pain, while adolescents and adults are more likely to present with dysphagia, heartburn, food impaction, and regurgitation (Table 1).⁵

EoE reference score, EREFS representing Edema, Rings, Exudate, Furrows and Stricture is used for endoscopic findings. Patients suspected of having EoE undergo esophagogastroduodenoscopy (EGD) to assess the extent of eosinophilic infiltration. Diagnostic criteria and other conditions with associated esophageal eosinophilia are listed in Table 1. Patients who have ≥15 eosinophils/high-powered field should be evaluated for EoE.6 EoE is patchy – at least 6 biopsies are needed at 2 esophageal levels in any patient with dysphagia.³ Of note, failure of a trial of proton pump inhibitors (PPI) is no longer part of the diagnostic criteria for EoE. Differentiating between EoE and GERD can be particularly challenging due to the similarity in their clinical signs.