Eosinophilic Esophagitis: Diagnosis and Current Management

Abstract

Eosinophilic esophagitis (EoE) is an eosinophil-rich, Th2 antigen-mediated disease of increasing worldwideprevalence. Originally considered common in children and young adults, it can be seen at any age, withthe highest prevalence between 30 and 40 years. Symptoms reflect esophageal dysfunction, and typicalendoscopic pictures consist of rings, furrows, exudates and edema. Progressive disease leads to pathologictissue remodeling, with ensuing esophageal rigidity and loss of luminal diameter caused by strictures. Thedefinitive diagnosis is histological (at least 15 eosinophils/HPF, high power field), upper gastrointestinalendoscopy with multiple esophageal biopsies being mandatory. Current therapeutic options include dietaryand pharmacologic treatments. Despite being successful in a high proportion of patients, elemental diet hasmultiple disadvantages. Therefore, a step-up approach (using a two-, four- and six food elimination diets) ispreferred, being globally effective in up to 79% of cases and avoiding unnecessary restrictions. Drug therapyrelies on proton pump inhibitors and topical corticosteroids. Esophageal dilation may be required to increaseluminal patency, leading to immediate symptomatic improvement in 95% of EoE patients, who have stricturesor narrow caliber esophagus. The chronic nature of the disease necessitates long-term therapy. In this review,current diagnostic and treatment options are discussed and a treatment algorithm is proposed.