Eosinophilic Esophagitis and the Patient Presenting With Dysphagia (2024 AMW)

Eosinophilic esophagitis (EoE) is a chronic immune mediated disease of the esophagus that is increasingly recognized as a cause of dysphagia in children and adults. Over the past 3 decades, EoE has transformed from a little-known condition to a well-characterized, chronic, clinicopathologic disease often encountered in clinical practice by otolaryngologists in patients presenting for evaluation of dysphagia. EoE is characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. It significantly affects patients’ quality of life and, if left untreated, can result in fibrotic complications. This session will provide a comprehensive review of the pathophysiology of EoE, starting from major pathogenic mechanisms (genetics, type 2 inflammation, epithelial barrier dysfunction, gastroesophageal reflux, allergens, infections and microbiota), diagnostic criteria including endoscopic findings and biopsy requirements, and treatment including elimination diets, proton pump inhibitors (PPIs), topical steroids, and most recently biologics. The aim of treatment is to improve clinical symptoms while obtaining mucosal healing and avoiding long-term complications. Diagnostic guidelines and evidence-based management recommendations will be reviewed. Despite advances over the past 30 years, important knowledge gaps about EoE remain and future therapeutic targets will be discussed as well.