Eosinophilic esophagitis: current evidence-based diagnosis and treatment in children and adults

Eosinophilic esophagitis (EoE) is a disease caused by an immune response to food antigens in contact with the esophageal mucosa that has arisen as a common disorder in current clinical practice. Its diagnosis is defined by the combination of symptoms of esophageal dysfunction and inflammation of the esophageal mucosa predominantly by eosinophils. Its chronic course and frequent progression to subepithelial fibrosis leading to strictures and narrow esophagus indicate the need for treatment. Information provided by recent clinical trials and systematic reviews allowed for the development of new clinical guidelines, endorsed by several European scientific societies. This review summarizes its most relevant aspects, updates the concept of EoE, reports its epidemiology and risk factors, associated conditions and its natural history in children and adults. Diagnostic criteria of EoE were updated, after the relationships discovered between the disease and gastroesophageal reflux disease. Endoscopy with biopsies remains as the only accurate test for diagnosis and monitoring, which warrants research on minimally invasive methods. Therapeutic options for EoE are analyzed based on best scientific evidence and expert opinion. Drugs with anti-inflammatory efficacy include proton pump inhibitors and topic swallowed steroids. Empiric food elimination diets have been shown to be superior to skin allergy testing food elimination. Since only one or two foods are involved in causing EoE in 90% of patients who respond to diets, novel steep-up schemes on empiric elimination diets warrant further evaluation. Endoscopic dilation should be considered in patients with esophageal narrowing and persistent symptoms unresponsive to diet or drugs-based anti-inflammatory treatments.