Eosinophilic Esophagitis in Upper Endoscopy Patients with Gastrointestinal Complaints

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized by eosinophil-predominant inflammation and symptoms of esophageal dysfunction. Defined histologically by ≥15 eosinophils per high-power field, EoE has emerged as a major cause of dysphagia and food impaction in adults and children, with prevalence ranging from 0.05–0.4% in the general population but reaching 15% among patients with dysphagia and 48% in those with food bolus impaction. EoE demonstrates strong male predominance (3:1) and frequent association with atopic comorbidities including asthma, allergic rhinitis, and atopic dermatitis, reflecting its Th2-driven immunoallergic pathogenesis mediated by IL-4, IL-5, and IL-13. Despite increasing recognition, EoE remains frequently misdiagnosed due to clinical and endoscopic overlap with gastroesophageal reflux disease (GERD), leading to prolonged empirical proton pump inhibitor (PPI) therapy and diagnostic delay. Characteristic endoscopic features mucosal edema, longitudinal furrows, concentric rings, white exudates, and strictures are systematically evaluated using the EoE Endoscopic Reference Score (EREFS). However, 10–25% of patients exhibit normal-appearing mucosa, necessitating systematic esophageal biopsies regardless of endoscopic appearance. Routine laboratory markers lack discriminatory value, making histopathological examination the diagnostic gold standard. Early diagnosis is critical to prevent irreversible fibrotic remodeling and optimize therapeutic outcomes through the "3D" approach: dietary elimination, drugs (topical corticosteroids, PPIs), and dilation. Identifying clinical and endoscopic predictors can reduce diagnostic delays and guide timely biopsy sampling in at-risk populations, thereby improving patient outcomes in routine gastroenterological practice.