Optimizing the Endoscopic Examination in Eosinophilic Esophagitis

  • Evan S. Dellon
    Reprint requests Address requests for reprints to: Evan S. Dellon, MD, MPH, CB#7080, Bioinformatics Building, 130 Mason Farm Road, UNC-CH, Chapel Hill, North Carolina 27599-7080. fax: (919) 843-2508.
    Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
    Search for articles by this author
Published:August 02, 2021DOI:
      With its increasing incidence and prevalence, providers will encounter eosinophilic esophagitis (EoE) more commonly in clinical practice. In the endoscopy suite, in particular, the suspicion for this condition should be high. Prior studies have shown that ~6% of all patients undergoing upper endoscopy for any reason, >15% having endoscopy for dysphagia, and >50% requiring endoscopy in the setting of a food impaction, will be diagnosed with EoE.
      • Dellon E.S.
      • Hirano I.
      Epidemiology and natural history of eosinophilic esophagitis.
      In this context, a careful esophageal examination is critical. For EoE, this helps to not only optimize diagnosis, but allows potential therapeutics, such as dilation in patients with esophageal strictures or narrowing, and sets the stage for monitoring treatment response and assessing outcomes.

      Abbreviations used in this paper:

      EoE (eosinophilic esophagitis), EREFS (EoE Endoscopic Reference Score)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dellon E.S.
        • Hirano I.
        Epidemiology and natural history of eosinophilic esophagitis.
        Gastroenterology. 2018; 154: 319-322
        • Hirano I.
        • Moy N.
        • Heckman M.G.
        • et al.
        Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system.
        Gut. 2013; 62: 489-495
        • van Rhijn B.D.
        • Warners M.J.
        • Curvers W.L.
        • et al.
        Evaluating the endoscopic reference score for eosinophilic esophagitis: moderate to substantial intra- and interobserver reliability.
        Endoscopy. 2014; 46: 1049-1055
        • Dellon E.S.
        • Cotton C.C.
        • Gebhart J.H.
        • et al.
        Accuracy of the eosinophilic esophagitis endoscopic reference score in diagnosis and determining response to treatment.
        Clin Gastroenterol Hepatol. 2016; 14: 31-39
        • Wechsler J.B.
        • Bolton S.
        • Amsden K.
        • et al.
        Eosinophilic esophagitis reference score accurately identifies disease activity and treatment effects in children.
        Clin Gastroenterol Hepatol. 2018; 16: 1056-1063
        • Gentile N.
        • Katzka D.
        • Ravi K.
        • et al.
        Oesophageal narrowing is common and frequently under-appreciated at endoscopy in patients with oesophageal eosinophilia.
        Aliment Pharmacol Ther. 2014; 40: 1333-1340
        • Menard-Katcher C.
        • Swerdlow M.P.
        • Mehta P.
        • et al.
        Contribution of esophagram to the evaluation of complicated pediatric eosinophilic esophagitis.
        J Pediatr Gastroenterol Nutr. 2015; 61: 541-546
        • Eluri S.
        • Tappata M.
        • Huang K.Z.
        • et al.
        Distal esophagus is the most commonly involved site for strictures in patients with eosinophilic esophagitis.
        Dis Esophagus. 2020; 33 (doz088(2). Epub 2019/11/30)
        • Dellon E.S.
        • Speck O.
        • Woodward K.
        • et al.
        Distribution and variability of esophageal eosinophilia in patients undergoing upper endoscopy.
        Mod Pathol. 2015; 28: 383-390
        • Gonsalves N.
        • Policarpio-Nicolas M.
        • Zhang Q.
        • et al.
        Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis.
        Gastrointest Endosc. 2006; 64: 313-319