Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized clinically by symptoms of esophageal dysfunction (most often dysphagia and food impaction in adults) and histologically by eosinophil-predominant inflammation (≥15 eosinophils per high-power field on biopsy). It is now the most common cause of food impaction in young adults.

The endoscopic findings are graded with the EREFS score: Edema (loss of vascular pattern), Rings (concentric trachealization), Exudates (white plaques of eosinophil collections), Furrows (longitudinal lines), and Strictures. A normal-appearing esophagus does not exclude EoE — biopsies should be obtained from the proximal and distal esophagus regardless of appearance whenever EoE is suspected.

First-line treatment is the "three D's": diet (six-food elimination or empiric removal of dairy/wheat), drugs (proton pump inhibitors, swallowed topical corticosteroids, or biologic therapy with dupilumab), and dilation for fibrostenotic strictures. Disease control is monitored both by symptoms and by repeat biopsy, since symptom remission does not always reflect histologic response.