Katherine Alexander, MHS, PA-C

Accurate EoE diagnosis requires more than recognizing symptoms. The expert faculty highlight how clinical suspicion, appropriate biopsy sampling, histology, and endoscopic findings come together to establish a confident diagnosis.

Establishing a Confident EoE Diagnosis

In this episode, ‘Establishing a Confident EoE Diagnosis,’ the expert advanced practice providers explore the clinical and diagnostic considerations that support accurate identification of eosinophilic esophagitis (EoE). The panel discusses when symptoms such as dysphagia, food impaction, longstanding adaptive eating behaviors, and atopic comorbidities should prompt referral for endoscopic evaluation with esophageal biopsies. They emphasize the important role of communication between advanced practice providers and endoscopists to ensure that the clinical suspicion for EoE is clearly conveyed and appropriate biopsies are obtained, even when the esophagus appears normal.

The panelists also highlight patient education as an important part of the diagnostic process, particularly in helping patients understand why endoscopic evaluation may still be necessary despite previously normal imaging or other testing. They then review the components of a confident EoE diagnosis, including symptoms of esophageal dysfunction, appropriate biopsy sampling, and the histologic threshold of at least 15 eosinophils per high-power field. The expert faculty discuss recommendations to obtain multiple biopsies from different levels of the esophagus to improve diagnostic accuracy.

Finally, the panel examines how clinical presentation, endoscopic findings, and histology can help differentiate EoE from other potential causes of esophageal eosinophilia, particularly gastroesophageal reflux disease. They also discuss the value of standardized endoscopic assessment, including the EoE Endoscopic Reference Score, for establishing a baseline that can support evaluation throughout the patient journey.

The next episode in this series, ‘The Importance of Early Diagnosis in EoE,

 features the panelists discussing how diagnostic delays and persistent inflammation can contribute to progressive esophageal remodeling and fibrostenotic complications. They also share practical strategies for helping patients understand the importance of early diagnosis and disease control.

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EoE does not always present as straightforward dysphagia. The panel explores how adaptive eating behaviors, age-specific presentations, atopic comorbidities, and food impaction can provide critical clues for earlier recognition and diagnosis.

Recognizing EoE Across Pediatric and Adult Patients

Welcome back to another HCPLive Peer Exchange series. In this episode titled, “Recognizing EoE Across Pediatric and Adult Patients,” expert faculty examine the symptoms, eating behaviors, and comorbidities that can raise suspicion for eosinophilic esophagitis (EoE) and discuss how clinical presentation can differ by age.

The panel highlights dysphagia as a hallmark symptom of EoE in adults while emphasizing that patients may not describe swallowing difficulty directly. Instead, clinicians may uncover adaptive eating behaviors, such as cutting food into small pieces, avoiding certain textures, using liquids to help food pass, or having difficulty swallowing pills. In pediatric patients, EoE may present differently, with abdominal pain, failure to thrive, nutritional deficiencies, food refusal, or texture preferences. The panel also discusses the importance of assessing for associated type 2 inflammatory conditions, including food allergies, atopic dermatitis, asthma, and allergic rhinitis.

As recognition of EoE has increased, the panelists describe adopting a more proactive approach to patients with dysphagia or GERD-like symptoms, including maintaining a high index of suspicion and considering earlier endoscopic evaluation with biopsy. They also examine food impaction as an important presentation of EoE and explain why a detailed history can uncover previous episodes of food sticking that patients may have normalized. The discussion concludes by emphasizing the importance of obtaining biopsies during endoscopy for food impaction when appropriate, helping establish an EoE diagnosis while reducing the potential for patients to be lost to follow-up.

The next episode in this series, ‘Establishing a Confident EoE Diagnosis,’ features the panelists discussing when suspected EoE warrants endoscopic evaluation and biopsy and the clinical, histologic, and endoscopic findings needed to support an accurate diagnosis. The panel also explores differentiating EoE from other causes of esophageal eosinophilia and the importance of collaboration across the care team.

Katherine Alexander, MHS, PA-C

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