Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Gastroenterology
Published in: Journal of Gastroenterology 9/2020

01-09-2020 | Eosinophilic Esophagitis | Review

Symptom-based diagnostic approach for eosinophilic esophagitis

Author: Yasuhiro Fujiwara

Published in: Journal of Gastroenterology | Issue 9/2020

Login to get access

Abstract

The prevalence of eosinophilic esophagitis (EoE) has been increasing in Japan. Although the diagnosis of EoE is based on simple criteria that include the presence of esophageal symptoms and esophageal eosinophilia on biopsies, there are several important issues associated with the diagnostic approach. Following an extensive literature search, the symptoms of 886 EoE cases in Japanese adults were analyzed and divided into three categories as follows: (1) typical symptoms, such as dysphagia (53%); (2) other upper GI symptoms (40%); and (3) no symptoms found during screening or medical examination, i.e., “asymptomatic esophageal eosinophilia” (19%). The diagnostic approach was reviewed according to these categories as well as according to the presence or absence of esophageal eosinophilia. The present manuscript describes the current therapeutic strategy of EoE and ultimately proposes a symptom-based diagnostic approach for EoE.
Literature
1.
Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108:679–92.PubMed
2.
Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017;5:335–58.PubMedPubMedCentral
3.
Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis proceedings of the agree conference. Gastroenterology. 2018;155:1022–33.PubMed
4.
Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018;154:319–32.PubMed
5.
Kinoshita Y, Ishimura N, Oshima N, et al. Systematic review: eosinophilic esophagitis in Asian countries. World J Gastroenterol. 2015;21:8433–40.PubMedPubMedCentral
6.
Ishimura N, Kinoshita Y. Eosinophilic esophagitis in Japan: Focus on response to acid suppressive therapy. J Gastroenterol Hepatol. 2018;33:1016–22.PubMed
7.
Kinoshita Y, Ishihara S. Eosinophilic gastroenteritis: epidemiology, diagnosis, and treatment. Curr Opin Allergy Clin Immunol. 2020;18:5.
8.
Haruma K. Eosinophilic esophagitis: time for clinical practice. Esophagus. 2019;16:331–2.PubMed
9.
Dellon ES, Gibbs WB, Fritchie KJ, et al. Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2009;7:1305–13.PubMedPubMedCentral
10.
Remedios M, Campbell C, Jones DM, et al. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc. 2006;63:3–12.PubMed
11.
Adachi K, Okada M, Mishiro T, et al. Clinical features and prognosis of eosinophilic esophagitis case diagnosed by upper GI endoscopic screening (in Japanese). Stomach and Intestine. 2018;53:323–31.
12.
Sato H, Honma T, Nozawa Y, et al. Eosinophilic esophagitis in Japanese patients: a mild and slow-progressing disorder. PLoS ONE. 2018;13:e0206621.PubMedPubMedCentral
13.
Tanaka F, Fukumoto S, Morisaki T, et al. Obesity and hiatal hernia may be non-allergic risk factors for esophageal eosinophilia in Japanese adults. Esophagus. 2019;16:309–15.PubMed
14.
Ishibashi F, Fukushima K, Onizuka R, et al. Risk of progression to eosinophilic esophagitis in patients with asymptomatic esophageal eosinophilia: a retrospective pilot study. J Gastroenterol Hepatol Open. 2019;1:7.
15.
Abe Y, Iijima K, Ohara S, et al. A Japanese case series of 12 patients with esophageal eosinophilia. J Gastroenterol. 2011;46:25–30.PubMed
16.
Fujishiro H, Amano Y, Kushiyama Y, et al. Eosinophilic esophagitis investigated by upper gastrointestinal endoscopy in Japanese patients. J Gastroenterol. 2011;46:1142–4.PubMed
17.
Fujiwara Y, Sugawa T, Tanaka F, et al. A multicenter study on the prevalence of eosinophilic esophagitis and PPI-responsive esophageal eosinophilic infiltration. Intern Med. 2012;51:3235–9.PubMed
18.
Kinoshita Y, Furuta K, Ishimaura N, et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol. 2013;48:333–9.PubMed
19.
Tomomatsu Y, Yoshino J, Inui K, et al. Clinical features of eosinophilic esophagitis ten Japanese cases. Dig Endosc. 2013;25:117–24.PubMed
20.
Hori K, Watari J, Fukui H, et al. Do endoscopic features suggesting eosinophilic esophagitis represent histological eosinophilia? Dig Endosc. 2014;26:156–63.PubMed
21.
Abe Y, Iijima K, Ohara S, et al. Localized esophageal eosinophilia: Is it an early manifestation of eosinophilic esophagitis or a subtype of gastroesophageal reflux disease? Dig Endosc. 2014;26:337–43.PubMed
22.
Shimura S, Ishimura N, Tanimura T, et al. Reliability of symptoms and endoscopic findings for diagnosis of esophageal eosinophilia in a Japanese population. Digestion. 2014;90:49–57.PubMed
23.
Kusunose H, Ohara S, Hamada S, et al. The investigation of clinical features of eosinophilic esophagitis and the possibility of acid related disease judged the effects of PPIs (in Japanese). Therapeutic Res. 2014;35:377–82.
24.
Iwakura N, Fujiwara Y, Tanaka F, et al. Basophil infiltration in eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia. Aliment Pharmacol Ther. 2015;41:776–84.PubMed
25.
Ishimura N, Ishihara S, Kinoshita Y. Sustained Acid suppression by potassium-competitive acid blocker (P-CAB) may be an attractive treatment candidate for patients with eosinophilic esophagitis. Am J Gastroenterol. 2016;111:1203–4.PubMed
26.
Jiao D, Ishimura N, Maruyama R, et al. Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients. J Gastroenterol. 2017;52:203–10.PubMed
27.
Okimoto E, Ishimura N, Okada M, et al. Specific locations of linear furrows in patients with esophageal eosinophilia. Dig Endosc. 2017;29:49–56.PubMed
28.
Okimoto K, Arai M, Ishigami H, et al. A prospective study of eosinophilic esophagitis and the expression of tight junction proteins in patients with gastroesophageal reflux disease symptoms. Gut Liver. 2018;12:30–7.PubMed
29.
Ishimura N, Sumi S, Okada M, et al. Ankylosaurus back sign: novel endoscopic finding in esophageal eosinophilia patients indicating proton pump inhibitor response. Endosc Int Open. 2018;6:E165–E172172.PubMedPubMedCentral
30.
Ishimura N, Sumi S, Okada M, et al. Is Asymptomatic esophageal eosinophilia the same disease entity as eosinophilic esophagitis? Clin Gastroenterol Hepatol. 2019;17:1405–7.PubMed
31.
Sawada A, Hashimoto A, Uemura R, et al. Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors. Endosc Int Open. 2019;7:E433–E439439.PubMedPubMedCentral
32.
Takashima S, Tanaka F, Otani K, et al. Barrett’s esophagus is negatively associated with eosinophilic esophagitis in Japanese subjects. Esophagus. 2019;16:168–73.PubMed
33.
Horiki N, Maruyama M, Fujita Y, et al. A case of idiopathic eosinophilic esophagitis with CT finding showing marked thickening of the esophageal wall (in Japanese). Nihon Shokakibyo Gakkai Zasshi. 1998;1:769–76.
34.
Furuta K, Adachi K, Kowari K, et al. A Japanese case of eosinophilic esophagitis. J Gastroenterol. 2006;41:706–10.PubMed
35.
Kamimura K, Oosaki A, Sugahara S, et al. Eosinophilic esophagitis: a case report Effective treatment with systemic corticosteroids for the relapse of the disease. Clin J Gastroenterol. 2008;1:46–51.PubMed
36.
Minematsu H, Hayafuji K, Saito Y, et al. A case of eosinophilic esophagitis with pleural effusion (in Japanese). Gastroenterol Endosc. 2009;51:194–200.
37.
Sano H, Iwakiri K, Kawami N, et al. Eosinophilic esophagitis: a case report with a review of the literature. Clin J Gastroenterol. 2010;3:279–84.PubMed
38.
Fukuchi M, Sakurai S, Suzuki M, et al. Esophageal squamous cell carcinoma with marked eosinophil infiltration. Case Rep Gastroenterol. 2011;5:648–53.PubMedPubMedCentral
39.
Tamagawa Y, Miyake T, Mishiro T, et al. A case of eosinophilic esophagitis with atypical clinical course. Clin J Gastroenterol. 2011;4:202–6.PubMed
40.
Fujiwara Y, Muraki M, Kohata Y, et al. A case of eosinophilic esophagitis with a stricture successfully treated using fluticasone swallowing therapy. Gastroenterol Endosc. 2011;53:3523–8.
41.
Maruyama Y, Kageoka M, Ohata A, et al. A case of eosinophilic esophagitis (in Japanese). Stomach Intestine. 2011;46:1537–43.
42.
Tomomatsu Y, Yoshino J, Inui K, et al. A case of eosinophilic esophagitis (in Japanese). Stomach Intestine. 2011;46:1264–7.
43.
Fukuchi M, Sakurai S, Fukasawa T, et al. Two Japanese patients with esophageal eosinophilia detected by routine medical examination. Esophagus. 2012;9:25–8.
44.
Takashima S, Inaba T, Ishikawa S, et al. Two cases of eosinophilic esophagitis with white exudates during endoscopy (in Japanese). Clini Dig Tract. 2013;18:47–53.
45.
Oda J, Iriguchi Y, Mizutani M, et al. A case of eosinophilic esophagitis (in Japanese). Stomach Small Intestine. 2013;48:1939–44.
46.
Nakamura F, Yano M, Tamura U, et al. A case of eosinophilic esophagitis (in Japanese). Tokushima J Med. 2013;34:109–12.
47.
Tasaki S, Kawasaki T, Hayashi K. A case of eosinophilic esophagitis with GERD-like symptoms (in Japanese). Prog Dig Endo. 2013;83:90–1.
48.
Yamabe A, Irisawa A, Shibukawa G, et al. Clinical effects of eosinophilic esophagitis observed using endoscopic ultrasound. Clin J Gastroenterol. 2014;7:305–9.PubMed
49.
Kondo T, Uehara T, Takada T, et al. Recurrent back pain of eosinophilic esophagitis. Am J Med. 2015;128:e1–2.PubMed
50.
Kita Y, Tatewaki M, Furukawa M, et al. Six cases of eosinophilic esophagitis (in Japanese). Nigen Dock. 2014;29:503–8.
51.
Fujiwara Y, Iwakura N, Hashimoto A, et al. Successful treatment of localized eosinophilic esophagitis with a proton pump inhibitor (in Japanese). Gastroenterol Endosc. 2015;57:2436–40.
52.
Sasaki Y, Harada M, Kiya Y, et al. A case of eosinophilic esophagitis, the diagnosis was difficult by endoscopic findings (in Japanese). Progress Dig Endo. 2015;86:122–3.
53.
Fukuoka K, Izumi T, Yaku H, et al. A case of eosinophilic esophagitis caused by a cedar ball (in Japanese). Nihon Shokakibyo Gakkai Zasshi. 2015;112:1016–22.PubMed
54.
Miyaoka Y, Tsukano K, Ueno S, et al. A case of eosinophilic esophagitis complicated with Crohn’s disease (in Japanese). Gastroenterol Endosc. 2015;57:128–33.
55.
KitamuraH HT. Two cases of eosinophilic esophagitis (in Japanese). Jap J Clin Radiol. 2016;61:943–51.
56.
Kawashima K, Ishihara S, Masuhara M, et al. Development of eosinophilic esophagitis following sublingual immunotherapy with cedar pollen extract: a case report. Allergol Int. 2018;67:515–7.PubMed
57.
Matsuura H, Muro S, Yamauchi K. Eosinophilic esophagitis: crepe paper-like appearance. Am J Med. 2018;131:e99–e100.PubMed
58.
Tanaka S, Toyonaga T, Kawara F, et al. A case of Jackhammer esophagus caused by eosinophilic esophagitis in which per-oral endoscopic myotomy resulted in symptom improvement. Clin J Gastroenterol. 2018;11:377–81.PubMed
59.
Mitani K, Kubo T, Saito T, et al. A case of eosinophilic esophagitis developed after cessation of ICS/LTRA therapy (in Japanese). Med J Nara Pref Western Med Center. 2018;7:117–20.
60.
Kinugasa H, Tanaka T, Okada H. Esophageal melanosis with eosinophilic esophagitis. Gastrointest Endosc. 2019;S0016–5107(19):32544–51.
61.
Owaki T, Sato H, Horigome R, et al. Eosinophilic esophagitis after total gastrectomy treated with proton pump inhibitors: a case report. Clin J Gastroenterol. 2019;12:420–3.PubMed
62.
Yamazaki K, Kojima K, Iwata H, et al. Eosinophilic Esophagitis Mimicking Candida Esophagitis. Intern Med. 2019;58:887.PubMed
63.
Kojima S, Katsuhara M, Takeuchi T, et al. A case of eosinophilic esophagitis that transformed from the localized type to the diffuse type (in Japanese). Gastroenterol Endosc. 2019;61:1395–400.
64.
Fujiwara Y, Hashimoto A, Uemura R, et al. Optimal biopsy protocol to evaluate histological effectiveness of proton pump inhibitor therapy in patients with eosinophilic esophagitis. Digestion. 2019;100:64–71.PubMed
65.
Hirano I, Moy N, Heckman MG, et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62:489–95.PubMed
66.
Hirano I. Clinical relevance of esophageal subepithelial activity in eosinophilic esophagitis. J Gastroenterol. 2020;55:249–60.PubMed
67.
Izumi D, Ishimura N, Okada M, et al. Poor inter-observer agreement on the endoscopic diagnosis of eosinophilic esophagitis among Japanese endoscopists. Esophagus. 2017;14:309–16.
68.
Fujiwara Y, Tanigawa T, Yamagami H, et al. Eosinophilic esophagitis-like endoscopic findings in patients with erosive esophagitis. Esophagus. 2013;10:199–204.
69.
Aziz Q, Fass R, Gyawali CP, et al. Functional Esophageal Disorders. Gastroenterology. 2016;150:1368–79.
70.
Fass R. Proton pump inhibitor failure–what are the therapeutic options? Am J Gastroenterol. 2009;104(Suppl 2):S33–S38.PubMed
71.
Kawami N, Takenouchi N, Umezawa M, et al. Pathogenesis of double-dose proton pump inhibitor-resistant non-erosive reflux disease, and mechanism of reflux symptoms and gastric acid secretion-suppressive effect in the presence or absence of helicobacter pylori infection. Digestion. 2017;95:140–5.PubMed
72.
Adachi K, Mishiro T, Tanaka S, et al. Suitable biopsy site for detection of esophageal eosinophilia in eosinophilic esophagitis suspected cases. Dig Endosc. 2016;28:139–44.PubMed
73.
Fujiwara Y, Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population. J Gastroenterol. 2009;44:518–34.PubMed
74.
Kohata Y, Fujiwara Y, Kato K, et al. Successful treatment of betamethasone syrup on autoimmune esophagitis. Am J Gastroenterol. 2014;109:451–3.PubMed
75.
Nakamura R, Omori T, Suda K, et al. Endoscopic findings of laryngopharyngeal and esophageal involvement in autoimmune bullous disease. Dig Endosc. 2017;29:765–72.PubMed
76.
Toya Y, Nakamura S, Tomita K, et al. Dabigatran-induced esophagitis: the prevalence and endoscopic characteristics. J Gastroenterol Hepatol. 2016;31:610–480.PubMed
77.
Matsushita T, Maruyama R, Ishikawa N, et al. The number and distribution of eosinophils in the adult human gastrointestinal tract: a study and comparison of racial and environmental factors. Am J Surg Pathol. 2015;39:521–7.PubMed
78.
Odiase E, Schwartz A, Souza RF, et al. New eosinophilic esophagitis concepts call for change in proton pump inhibitor management before diagnostic endoscopy. Gastroenterology. 2018;154:1217–21.PubMed
79.
Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380–92.PubMed
80.
Straumann A, Blanchard C, Radonjic-Hoesli S, et al. A new eosinophilic esophagitis (EoE)-like disease without tissue eosinophilia found in EoE families. Allergy. 2016;71:889–900.PubMed
81.
Greuter T, Simon D, Collins MH, et al. Eosinophilic esophagitis-like disease with lack of significant esophageal eosinophilia: Description of a new disease entity. Gastroenterology. 2019;156:S72.
82.
Sato H, Takeuchi M, Takahashi K. Eosinophilic infiltration of the muscularis propria in a patient with jackhammer esophagus treated with per-oral endoscopic myotomy. Clin Gastroenterol Hepatol. 2015;13:e33–e34.PubMed
83.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v.30. Neurogastroenterol Motil. 2015;27:160–74.PubMed
84.
Sato H, Nakajima N, Hasegawa G, et al. Immunohistochemical differentiation of eosinophilic esophageal myositis from eosinophilic esophagitis. J Gastroenterol Hepatol. 2017;32:106–13.PubMed
85.
Sato H, Nakajima N, Takahashi K, et al. Proposed criteria to differentiate heterogeneous eosinophilic gastrointestinal disorders of the esophagus, including eosinophilic esophageal myositis. World J Gastroenterol. 2017;23:2414–23.PubMedPubMedCentral
86.
Sato H, Terai S. Eosinophilic esophageal myositis (EoEM) causes jackhammer esophagus, rarely posing a problem in the differential diagnosis of eosinophilic esophagitis. Am J Gastroenterol. 2018;113:1263–4.PubMed
87.
Igarashi R, Irisawa A, Shibukawa G, et al. Eosinophilic esophageal myositis diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report. Clin J Gastroenterol. 2016;9:285–8.PubMed
88.
Spechler SJ. Eosinophilic esophagitis: novel concepts regarding pathogenesis and clinical manifestations. J Gastroenterol. 2019;54:837–44.PubMedPubMedCentral
89.
Spechler SJ, Konda V, Souza R. Can eosinophilic esophagitis cause achalasia and other esophageal motility disorders? Am J Gastroenterol. 2018;113:1594–9.PubMed
90.
Philpott H, Dellon ES. The role of maintenance therapy in eosinophilic esophagitis: who, why, and how? J Gastroenterol. 2018;53:165–71.PubMed
91.
Fujiwara Y, Hashimoto A. Treatment for eosinophilic esophagitis (in Japanese). Stomach Intestine. 2018;53:317–22.
92.
Iwakiri K, Kinoshita Y, Habu Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol. 2016;51:751–67.PubMed
Metadata
Title
Symptom-based diagnostic approach for eosinophilic esophagitis
Author
Yasuhiro Fujiwara
Publication date
01-09-2020
Publisher
Springer Singapore
Published in
Journal of Gastroenterology / Issue 9/2020
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-020-01701-y

Other articles of this Issue 9/2020

Journal of Gastroenterology 9/2020 Go to the issue

Original Article—Liver, Pancreas, and Biliary Tract

Serum hepatitis B core-related antigen predicts hepatocellular carcinoma in hepatitis B e antigen-negative patients

Review

The shining DIAMOND for evidence-based treatment strategies for Crohn’s disease

Original Article—Liver, Pancreas, and Biliary Tract

The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study

Original Article—Alimentary Tract

Traditional serrated adenoma has two distinct genetic pathways for molecular tumorigenesis with potential neoplastic progression

Original Article—Liver, Pancreas, and Biliary Tract

Infectious complications and timing for liver transplantation in autoimmune acute liver failure in Japan: a subanalysis based on nationwide surveys between 2010 and 2015

Review

An expert review on the use of tenofovir alafenamide for the treatment of chronic hepatitis B virus infection in Asia
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits