Low biopsy rate and PPI use: two persistent barriers in the diagnosis of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) can be identified in up to 7% of patients evaluated for esophageal symptoms. This proportion rises to 23% when dysphagia is the presenting symptom and can reach 50% in patients with a history of esophageal food impaction, according to an evidence-based review incorporating clinical trials, systematic reviews, and clinical guidelines. It is a chronic inflammatory disease whose natural history, in the absence of treatment, leads to fibrosis of the esophageal wall and stenosis, symptoms of esophageal dysfunction, and a decline in quality of life; therefore, early and appropriate diagnosis and treatment are necessary.