Endoscopic Diagnosis and Response Evaluation in Patients with Eosinophilic Esophagitis

Abstract

Abstract Purpose of review The aim of this review is to provide practical guidance for clinicians to support the optimal use of endoscopy in both the diagnosis and the evaluation of treatment response in patients with eosinophilic esophagitis (EoE). Recent findings The systematic and high-quality assessment and grading of EoE endoscopic features improves EoE detection. Fibrotic complications of EoE that negatively impact patients’ symptoms and quality of life can be detected and treated through endoscopy. The correlation between endoscopic features of EoE and histological activity remains challenging. However, assessment of endoscopic activity is fast and reliable in the evaluation of treatment response and, therefore, is supported by current guidelines. New modalities such as FLIP panometry and molecular markers for diagnosis and monitoring of EoE are promising, but whether they may replace endoscopy in guiding treatment of EoE needs to be ascertained. Summary Endoscopy plays a central role in EoE management, both in routine practice and in clinical trials. Endoscopy is pivotal in EoE diagnosis and response evaluation since it allows the direct assessment of endoscopic disease activity and, indirectly, the histological evaluation. Consequently, together with clinical and histological evaluation, endoscopy is rapidly becoming essential in monitoring the effectiveness of therapy in patients with EoE.