Unmet diagnostic needs in eosinophilic esophagitis

The description of eosinophilic esophagitis (EoE) from a clinical, endoscopic, histologic and mechanistic perspective has emerged at a rapid pace. Nevertheless, there are many key areas of diagnosis which remain problematic. The first area is trying to identify a gold standard for EoE, particularly in its differentiation from gastroesophageal reflux disease. As a result, many of the consensus guidelines advise expensive and cumbersome steps with endoscopy and empiric courses of medication that would not be needed should a completely accurate method for identifying EoE be developed. We also grapple with the lack of an accurate test short of endoscopy and biopsy to diagnose and monitor treatment response in EoE. This is particularly problematic in food elimination diets where patients may require up to ten endoscopies to determine precise food avoidance. Finally, it is imperative that we diagnose factors that predict severity and phenotype of the disease. This will yield far clearer guidance concerning the level and duration of therapy needed on EoE patients.