Establishing a Confident EoE Diagnosis

In this episode, ‘Establishing a Confident EoE Diagnosis,’ the expert advanced practice providers explore the clinical and diagnostic considerations that support accurate identification of eosinophilic esophagitis (EoE). The panel discusses when symptoms such as dysphagia, food impaction, longstanding adaptive eating behaviors, and atopic comorbidities should prompt referral for endoscopic evaluation with esophageal biopsies. They emphasize the important role of communication between advanced practice providers and endoscopists to ensure that the clinical suspicion for EoE is clearly conveyed and appropriate biopsies are obtained, even when the esophagus appears normal.

The panelists also highlight patient education as an important part of the diagnostic process, particularly in helping patients understand why endoscopic evaluation may still be necessary despite previously normal imaging or other testing. They then review the components of a confident EoE diagnosis, including symptoms of esophageal dysfunction, appropriate biopsy sampling, and the histologic threshold of at least 15 eosinophils per high-power field. The expert faculty discuss recommendations to obtain multiple biopsies from different levels of the esophagus to improve diagnostic accuracy.

Finally, the panel examines how clinical presentation, endoscopic findings, and histology can help differentiate EoE from other potential causes of esophageal eosinophilia, particularly gastroesophageal reflux disease. They also discuss the value of standardized endoscopic assessment, including the EoE Endoscopic Reference Score, for establishing a baseline that can support evaluation throughout the patient journey.

The next episode in this series, ‘The Importance of Early Diagnosis in EoE,’ features the panelists discussing how diagnostic delays and persistent inflammation can contribute to progressive esophageal remodeling and fibrostenotic complications. They also share practical strategies for helping patients understand the importance of early diagnosis and disease control.