Eosinophilic Esophagitis and Gastroesophageal Reflux Disease: There and Back Again  Ikuo Hirano, MD  Clinical Gastroenterology and Hepatology  Volume 9, Issue 2, Pages 99-101 (February 2011) DOI: 10.1016/j.cgh.2010.11.001 Copyright © 2011 AGA Institute Terms and Conditions

Figure 1 Suggested diagnostic approach to adult patient with EoE. EoE is suspected on the basis of a clinical profile of symptoms dominated by dysphagia and food impaction in a younger, typically male patient with history of atopy. Considerations in the decision to perform an EGD or to proceed with an empiric PPI trial at this juncture include symptom severity and preference to minimize testing. In cases where an EGD is available (*), features supportive of diagnosis of EoE include esophageal rings, longitudinal furrows, and exudates with histologic evidence of esophageal eosinophilia. Following a therapeutic trial of PPI therapy, an EGD differentiates PPI-responsive esophageal eosinophilia from the 2007 AGA Institute/NASPGHAN consensus recommendation for the diagnosis of primary EoE.15 It remains controversial whether the PPI-responsive form of esophageal eosinophilia represents GERD or a PPI-responsive subtype of EoE. Clinical Gastroenterology and Hepatology 2011 9, 99-101DOI: (10.1016/j.cgh.2010.11.001) Copyright © 2011 AGA Institute Terms and Conditions