Diagnosis
The diagnosis of EoE is dependent on three criteria which include symptoms of esophageal dysfunction, ≥ 15 eos/hpf on a histologic examination of the esophageal biopsy, and an evaluation for non-EoE disorders that cause or potentially contribute to esophageal eosinophilia.4 A diagnosis of EoE is not reliant on prior response to proton pump inhibitors (PPIs).4 The presence of other atopic diseases, including immediate-type food allergies, asthma, atopic dermatitis, and allergic rhinitis, should increase the suspicion of EoE.4 Furthermore, patients may develop adaptive eating and avoidance behaviors as a coping strategy for the symptoms of EoE, which can make symptom severity difficult to discern and result in diagnostic delays.4 These behaviors can be assessed using the IMPACT acronym, which includes imbibing fluids, modifying foods, prolonging mealtimes, avoiding hard-textured food, chewing excessively, and turning away tablets/pills.4 Endoscopic evaluation using the EREFS is strongly recommended to characterize the key features of EoE by severity, which include edema, rings, exudates, furrows, and strictures.4