Eosinophilic Esophagitis Should Not Be Diagnosed by Histology Alone

Response to high-dose proton-pump inhibitors suggests diagnoses other than EoE.

Eosinophilic esophagitis (EoE) is often diagnosed solely on the basis of esophageal eosinophilic infiltration (EEI) with a count of ≥15 eosinophils per high-power field (eos/hpf). This practice is counter to consensus recommendations for diagnostic criteria, one of which is the exclusion of gastroesophageal reflux disease (GERD) through response to high-dose proton-pump inhibitors (PPIs) or normal pH monitoring. Nevertheless, many clinicians have observed that a subset of patients with EoE respond to PPI therapy.

To investigate the response to PPIs among patients with EEI, researchers enrolled 712 adults who required endoscopic examinations for upper gastrointestinal symptoms and took endoscopic biopsies from the proximal/mid esophagus. Hist…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors