Eosinophilic esophagitis

• EoE is an atopic condition of the esophagus that has become increasingly recognized. • 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. • Patients with EoE should be referred to an allergist to help optimize treatment, and manage concurrent atopic conditions. • 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. • 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. • The elemental diet and empiric dietary restrictions are associated with high rates of clinical and histologic improvement in patients with EoE. • Pharmacologic management options include PPI, topical corticosteroids delivered to the esophagus or biologics. • Esophageal endoscopic dilation is most commonly used in adults with established esophageal strictures. • 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.