Eosinophilic Esophagitis and the Eosinophilic Gastrointestinal Diseases: Approach to Diagnosis and Management Erin C. Steinbach, MD, PhD, Michelle Hernandez,

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Presentation transcript:

Eosinophilic Esophagitis and the Eosinophilic Gastrointestinal Diseases: Approach to Diagnosis and Management Erin C. Steinbach, MD, PhD, Michelle Hernandez, MD, Evan S. Dellon, MD, MPH The Journal of Allergy and Clinical Immunology: In Practice Volume 6, Issue 5, Pages 1483-1495 (September 2018) DOI: 10.1016/j.jaip.2018.06.012 Copyright © 2018 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 1 A range of endoscopic findings in eosinophilic esophagitis (EoE) with application of the EoE endoscopic reference score classification, which measures the 5 main endoscopic features of EoE: edema, rings, exudates, furrows, and strictures. Edema is graded as absent (0) or present (1); rings are graded as absent (0), mild (1), moderate (2), or severe (3); exudates are graded as absent (0), mild (1), or severe (2); furrows are graded as absent (0), mild (1), or severe (2); stricture are graded as absent (0) or present (1), and if present the inner diameter can also be reported. A, A patient with suspected EoE, but with a normal endoscopy. B, A patient with edema, exudates, and furrows. C, A patient with edema, rings, exudates, furrows, and a stricture. D, A patient with edema, rings, exudates, furrows, and a stricture. E, A patient with edema and furrows. F, A patient with edema, rings, exudates, and furrows. The Journal of Allergy and Clinical Immunology: In Practice 2018 6, 1483-1495DOI: (10.1016/j.jaip.2018.06.012) Copyright © 2018 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 2 Dietary reintroduction of food allergen groups for patients with eosinophilic esophagitis. Modified with permission from the paper by Spergel and Shuker148 and the paper by Dellon and Liacouras.104 The Journal of Allergy and Clinical Immunology: In Practice 2018 6, 1483-1495DOI: (10.1016/j.jaip.2018.06.012) Copyright © 2018 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 3 Algorithm for the diagnosis and management of eosinophilic esophagitis (EoE). “Response” refers to <15 eosinophils per high-powered field (eos/hpf) with resolution of symptoms. “No response” refers to ≥15 eos/hpf and persistence of symptoms. For patients with a histologic response but with ongoing symptoms, assessment should be made for a persistent esophageal stricture or alternative cause of symptoms (dysmotility, visceral hypersensitivity, etc.). Patients with no histologic response but with resolution of symptoms may have undergone prior esophageal dilation and should be assessed for dietary avoidance or modification behaviors. PPI, Proton pump inhibitor. The Journal of Allergy and Clinical Immunology: In Practice 2018 6, 1483-1495DOI: (10.1016/j.jaip.2018.06.012) Copyright © 2018 American Academy of Allergy, Asthma & Immunology Terms and Conditions