Diagnosing eosinophilic esophagitis

Resumen

To the Editor, We recently read this interesting article in the journal: Esofagitis eosinofílica: diagnóstico y manejo1. After its description, eosinophilic esophagitis (EoE) has become an epidemiological and editorial phenomenon2. We would like to highlight several points, including those related to the definition of EoE. This has gone through some stages; the first diagnostic guide was done in 2007 and was updated in 2011. The last international consensus for the diagnostic criteria of EoE was carried out in 20183 and indicates that several aspects are necessary: - the presence of symptoms of esophageal dysfunction, - in esophageal histology the presence of ? 15 eosinophils per high-power field (hpf). Eosinophilic infiltration should be isolated to the esophagus. Other aspects, such as endoscopic findings and atopic comorbidities increase the diagnostic suspicion, but they are not essential and may be absent. In the article published1, the diseases that cause or may contribute to esophageal eosinophilia are listed, and it is stated that according to the 2013 guidelines, these should be excluded. However, in the 2018 consensus, in addition to including PPI-responsive esophageal eosinophilia within the spectrum of EoE, it is stated that the diseases listed as conditions associated with esophageal eosinophilia should be evaluated rather than require their exclusion, since they can coexist in some cases, such as gastroesophageal reflux disease (GERD), which is one of the most complex differential diagnoses3. The esophageal motility disorders can also be clinically difficult to differentiate and an overlap has been described4. Other causes of esophageal eosinophilia are rare or have distinctive clinical features. In this regard, it is useful to take gastric and duodenal biopsy samples, which are always recommended in pediatric guidelines, and in adults, symptoms and endoscopic findings must be taken into account to obtain them. Since EoE is the same disease in children as in adults, the diagnostic criteria are applicable to all age groups3. Read more...