Current Diagnostic and Treatment Strategies for Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus diagnosed by the presence of esophageal symptoms accompanied by an esophageal eosinophilic infiltrate. EoE has an increasing worldwide prevalence and can be a cause of dysphagia and food impactions. There is an important role for the use of proton pump inhibitors in the diagnostic pathway of EoE. Treatment paradigms for EoE aim to minimize esophageal inflammation and improve symptom control. Dietary therapy targets dietary allergens and encompasses the elemental diet, the allergy testing-directed elimination diet, and the empiric elimination diet. Pharmacologic options include topical corticosteroids as the standard first-line treatment. Multiple other pharmacologic interventions are currently under investigation and are not recommended in the most recent guidelines. Endoscopic dilation is usually reserved for patients who relapse on pharmacologic or dietary regimens or who have symptomatic stricturing disease. This article provides a comprehensive discussion of existing diagnostic and management strategies for EoE.

Keywords: Eosinophilic esophagitis; corticosteroids; dietary therapy; dysphagia; proton pump inhibitors.

Figure.

Endoscopic images of patients with eosinophilic esophagitis showing white specks of esophageal mucosa consistent with eosinophilic microabscesses (A), ringed appearance of the esophagus (B), linear furrowing of esophageal mucosa (C), and esophageal food impaction (D).