Endoscopic assessment of eosinophilic esophagitis

Eosinophilic esophagitis(EoE) is a clinicopathologic, inflammatory disease of the esophagus with increasing prevalence. In adults, the condition presents with dysphagia and may result in food impaction. There are a number of endoscopic findings in patients with EoE that include esophageal rings, linear furrowing, white plaques, strictures, and edema. Although individually each of these features may be seen in other esophageal diseases; when combined they have a high specificity for the pathologic finding of esophageal eosinophilia. Prospective studies have identified the presence of endoscopically identified, esophageal signs in most children and adults with EoE. In this article, we highlight a number of recent studies, including the development of an endoscopic classification and grading system to describe the esophageal manifestations of EoE. Wealsodiscusstheresultsofrandomizedcontrolledtrialswithendpointsassessingendoscopic findings before and after diet therapy and corticosteroids. Fibrostenotic sequelae are common in patients with EoE, and a technique to measure esophageal distensibility, which has been shown to be a predictor of risk of future food impactions and need for esophageal dilation, is discussed. Endoscopic features of EoE play an important role in our current understanding of the complications of EoE and are an important component of the assessment of disease severity and treatment response. (C) 2014 Elsevier Inc. All rights reserved.