Eosinophilic esophagitis: diagnostic tests and criteria

Area of Science:

• Gastroenterology
• Immunology
• Pathology

Background:

• Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disorder.
• Diagnosis can be challenging due to the absence of pathognomonic clinical, endoscopic, or histopathologic features.

Purpose of the Study:

• To outline the clinical, endoscopic, and histologic characteristics of EoE.
• To review current diagnostic guidelines and propose an approach for EoE diagnosis.
• To highlight emerging diagnostic techniques for future use.

Main Methods:

• Review of current literature and diagnostic guidelines for EoE.
• Emphasis on clinicopathologic criteria for diagnosis.
• Inclusion of proton-pump inhibitor (PPI) trial to exclude PPI-responsive esophageal eosinophilia (PPI-REE) and gastroesophageal reflux disease.

Main Results:

• EoE diagnosis requires clinical symptoms of esophageal dysfunction, esophageal biopsy with ≥15 eosinophils/high-power field (with exceptions), and exclusion of other causes like PPI-REE.
• A PPI trial is standard for assessing PPI-REE and concomitant gastroesophageal reflux disease.

Conclusions:

• EoE is a complex, chronic, immune-mediated condition requiring a comprehensive diagnostic approach.
• Future diagnostic tools like symptom scores, biomarkers, and genetic testing are under development but not yet validated for routine use.