title: Eosinophilic esophagitis: Update in diagnosis and management. Position paper by the Italian Society of Gastroenterology and Gastrointestinal Endoscopy (SIGE).
abstract: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. The entity exists worldwide but has been most extensively studied in Western countries. However, a wide range of symptoms has been noticed such as chest pain or gastro-esophageal reflux disease-like symptoms. Upper gastro-intestinal endoscopy and esophageal biopsies are crucial for the diagnosis. Endoscopy might be normal or reveal typical patterns such as rings, furrows, exudates, edema, and stricture. Two to four biopsies should be performed both in the distal and in the proximal esophagus, and 15 eosinophils per high power field within the esophageal epithelium are the minimal threshold to diagnose eosinophilic esophagitis. Allergy testing is recommended, although its impact to orient treatment remains to be demonstrated. Eosinophilic esophagitis treatment includes medical treatment, diet and endoscopic dilation. Proton pump inhibitors are the first-line therapy as up to 50% of patients respond well to proton pump inhibitors irrespective of objective evidence of GERD. Topical viscous corticosteroids or elimination diet are the treatment of choice in case of unresponsiveness to proton pump inhibitors.
authors.affiliation: Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. Electronic address: nicola.debortoli@unipi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Gastroenterology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore, Policlinic, Department of Physiopathology and Transplantation, University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Penagini
authors.affiliation: Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
authors.forename: Santino
authors.initials: S
authors.lastname: Marchi
mesh_terms: D001706:Biopsy; D002637:Chest Pain / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000188:drug therapy*; D004947:Esophagus / Q000473:pathology*; D005762:Gastroenterology; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006801:Humans; D007558:Italy; D009092:Mucous Membrane / Q000473:pathology*; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012955:Societies, Medical
chemical_list: D054328:Proton Pump Inhibitors
keywords: Biopsies; Eosinophilic esophagitis; PPI-responsive eosinophilic esophagitis; Proton pump inhibitors; Steroids; Upper endoscopy