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Abstract

Over the past 10 years, eosinophilic esophagitis (EoE) has become increasingly recognized as a significant problem in a number of specialties, including adult and pediatric gastroenterology, allergy, and pathology. Clinical experiences and basic, translational, and clinical research performed by scientists and subspecialists continues to emphasize the fact that EoE is a chronic, antigen- or immune-mediated, clinicopathologic disorder that requires both the presence of clinical esophageal dysfunction and the appropriate histologic findings on esophageal biopsy. EoE is atypical of many other high-profile gastrointestinal diseases such as gastroesophageal reflux, celiac disease, and inflammatory bowel disease because there is no definitive diagnostic test, pathognomonic feature, or FDA-approved treatment, points that have led to misdiagnosis and/or improper treatment of patients. As such, the recent Consensus Recommendations in JACI (2011;128:3–20) have tried to offer some degree of consistency in diagnostic and therapeutic approaches for clinical care and research. These recommendations will continue to change with increasing clinical experience and research. Consistent with this issue, and emphasized in the comment above, is the fact that the most confusing, albeit important, aspect of EoE is the ability of clinicians to differentiate EoE from other causes of esophageal eosinophilia, specifically GERD, treated inactive EoE, as well as PPI-responsive esophageal eosinophilia. Currently, there remains a great deal of debate, even among those with extensive experience with this disease, on whether these disorders are discrete entities, interrelated, or a “spectrum of disease.” Although at first glance these distinctions may seem to be irrelevant, we believe that it is extremely important that clinicians exercise the time and effort to make a proper diagnosis, especially because the natural history and treatments are quite different. Making the diagnosis of EoE for someone who has GERD or PPI-responsive esophageal eosinophilia may lead to placing patients on inappropriate long-term steroids, difficult diets, and unnecessary consultations and procedures. The changes in our recent guidelines highlight this increased complexity (PPI-responsive esophageal eosinophilia, phenotypic/genotypic heterogeneity, and recognition of the limitations of clinical findings and histopathology as the only determinant of the diagnosis, therapeutic response, etc). In a relatively short time, tremendous progress has been made in the understanding of EoE, likely due to the multidisciplinary, collaborative/consensus approach in understanding this disease. Continued support for these efforts will allow more robust clinical, translational and basic science research that will lead to a greater understanding of the etiology, pathogenesis, genetics, diagnostic testing (gastrointestinal and allergic), and therapeutic choices for patients with EoE. Is There a Consensus About Eosinophilic Esophagitis?GastroenterologyVol. 143Issue 1PreviewLiacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3–20. Full-Text PDF