Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized. Diagnosis of the disorder is dependent on the patient's clinical manifestations and must be confirmed by histologic findings on esophageal mucosal biopsies. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review. center dot EoE is an atopic condition of the esophagus that has become increasingly recognized.center dot Endoscopic mucosal biopsy revealing >= 15 eosinophils/HPF in one or more specimens remains the most important diagnostic test for EoE, and is mandatory for diagnosis.center dot Patients with EoE should be referred to an allergist to help optimize treatment, and manage concurrent atopic conditions.center dot Skin or specific IgE blood testing for foods is not indicated for the identification of EoE triggers, as this is not an IgE-mediated disease.center dot A trial of PPI is no longer a diagnostic criterion for EoE. To simplify, there is no longer a need to consider the term PPI-REE clinically.center dot The elemental diet and empiric dietary restrictions are associated with high rates of clinical and histologic improvement in patients with EoE.center dot Pharmacologic management options include PPI, topical corticosteroids delivered to the esophagus or biologics.center dot Esophageal endoscopic dilation is most commonly used in adults with established esophageal strictures.center dot While it is unclear whether OIT causes or unmasks EoE, continuing or initiating OIT as long as EoE is well controlled could be considered. More research is needed.