Improving Diagnostic Evaluation in EoE

In this episode, ‘Improving Diagnostic Evaluation in EoE,’ the panelists explore how clinicians can recognize patients who warrant evaluation for eosinophilic esophagitis and improve the quality of the diagnostic workup. The experts emphasize that dysphagia and food impaction should clearly prompt further investigation, but adaptive eating behaviors may provide subtler clues. Patients may avoid problematic foods or normalize abnormal swallowing patterns because similar behaviors have developed gradually or are shared by family members.

The discussion then focuses on endoscopic evaluation. The panel explains that clinicians should assess for inflammatory findings such as edema, furrows, and exudates, as well as rings, strictures, reflux-related changes, and other potential causes of dysphagia. Importantly, a normal-appearing esophagus does not exclude EoE. Faculty stress that biopsies remain essential because disease can be patchy and visually subtle. They discuss obtaining multiple biopsies from different levels of the esophagus and using standardized EREFS documentation to objectively track endoscopic findings over time.

The experts also identify food impaction as an important diagnostic opportunity that is too often missed, particularly during urgent procedures. Failure to obtain biopsies may lead to patients being lost to follow-up once the acute obstruction is relieved. The panel highlights practical strategies for improving biopsy rates and emphasizes that systematic evaluation can shorten the interval between symptoms and diagnosis.

The next episode in this series, ‘Recognizing Progression and Fibrostenotic Disease in EoE,’ features the panelists discussing demographic misconceptions, diagnostic delay, and the

relationship between persistent inflammation and fibrostenotic progression.