EoE REQUIRES A LONG-TERM MANAGEMENT APPROACH THAT FOCUSES ON 3 KEY AREAS: SYMPTOMS, HISTOLOGY, ENDOSCOPIC APPEARANCE¹

Symptoms are one part of diagnosing and monitoring EoE, and can vary between patients and across age groups²

Symptoms often progress from feeding difficulties in young children to dysphagia and food impaction in adolescents and adults.

Adaptive behaviors can mask EoE symptoms and delay diagnosis, management, and disease surveillance^8,9

Most people with EoE develop adaptive behaviors (coping mechanisms) to help manage their symptoms and avoid food impactions.¹⁰

Adaptive behaviors can contribute to a delay in EoE diagnosis that can increase the risk of severe disease complications.^3,8

Consider asking your patients and caregivers questions to uncover these common adaptive behaviors¹¹

mbibe fluids with meals

odify foods (cut into small pieces/puree)

rolong meal times

void hard texture foods

hew excessively

urn away tablets/pills

Children may exhibit different types of adaptive behaviors than adult patients¹¹

Refusing food and pocketing food in their cheek
Difficulty advancing from pureed to solid food
Have trouble expanding their diet to include new flavors and textures

ACG, American College of Gastroenterology; ASGE, American Society for Gastrointestinal Endoscopy.

It’s important to look beyond symptoms and address persistent inflammation,
which can cause structural changes to the esophagus⁷

Histology can reveal eosinophilic infiltrate as well as other abnormalities¹

Esophageal eosinophil counts are used to establish a diagnosis of EoE and are commonly used to assess treatment outcomes: ≥15 EOS/HPF required for diagnosis of EoE.^1,12,13

Due to the patchiness of the disease, the ACG and ASGE recommend taking ≥6 biopsy samples from two distinct esophageal levels (proximal/mid, distal) to diagnose EoE.^1,4

Biopsy Sensitivity for EoE Diagnosis in Adult Patients (N=66)^14,a

^aUsing a criterion of ≥15 EOS/HPF.

Histology can be used to reveal tissue abnormalities driven by inflammatory cells and mediators other than eosinophils.¹

The ACG guidelines and ASGE consensus guidance recommend evaluating
endoscopic appearance and histology, and not symptoms alone,
 to assess EoE activity during treatment^1,4

Endoscopic appearance can reveal inflammatory and fibrostenotic structural changes in the esophagus^1,16,17

Endoscopic features can be used to help evaluate disease.

Endoscopic reference score (EREFS) assesses and grades the severity of 5 key esophageal features: edema, rings, exudates, furrows, and stricture.

The ACG guidelines and ASGE consensus paper recommend routinely using
EREFS when assessing EoE activity during endoscopy^1,4

EoE requires long-term comprehensive management

Aim for initial treatment response across 3 key areas¹³

Assess treatments to confirm response and disease control

Many patients don’t respond adequately to common therapies like PPIs and TCS, or lose response later on.^18,19

PPI, proton pump inhibitor; TCS, topical corticosteroid.

To maintain long-term control of EoE, ACG recommends:

References: 1. Aceves SS, Alexander JA, Baron TH, et al. Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference. Gastrointest Endosc. 2022;96(4):576-592.e1. 2. Muir AB, Brown-Whitehorn T, Godwin B, Cianferoni A. Eosinophilic esophagitis: early diagnosis is the key. Clin Exp Gastroenterol. 2019;12:391-399. 3. Cheng E, Souza RF, Spechler SJ. Tissue remodeling in eosinophilic esophagitis. Am J Physiol Gastrointest Liver Physiol. 2012;303(11):G1175-G1187. 4. Dellon E, Muir A, Katzka D, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol. 2025;120(1)31-59. 5. Hiremath GS, Hameed F, Pacheco A, Olive A, Davis CM, Shulman RJ. Esophageal food impaction and eosinophilic esophagitis: a retrospective study, systematic review, and meta-analysis. Dig Dis Sci. 2015;60(11):3181-3193. 6. Attwood S, Lamb C. Eosinophilic oesophagitis and other non-reflux inflammatory conditions of the oesophagus: diagnostic imaging and best management. Best Pract Res Clin Gastroenterology. 2008;22(4):639-660. 7. Safroneeva E, Straumann A, Schoepfer AM. Latest insights on the relationship between symptoms and biologic findings in adults with eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2018;28(1):35-45. 8. Schoepfer AM, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145(6):1230-1236.e2. 9. Gomez Torrijos E, Gonzalez-Mendiola R, Alvarado M, et al. Eosinophilic esophagitis: review and update. Front Med (Lausanne). 2018;5:247. doi:10.3389/fmed.2018.00247 10. de Rooij WE, Evertsz FB, Lei A, Bredenoord AJ. General well-being and coping strategies in adult eosinophilic esophagitis patients. J Neurogastroenterol Motil. 2022;28(3):390-400. 11. Hirano I, Furuta GT. Approaches and challenges to management of pediatric and adult patients with eosinophilic esophagitis. Gastroenterology. 2020;158(4):840-851. 12. 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(3):335-358. 13. Dellon ES, Gupta SK. A conceptual approach to understanding treatment response in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2019;17(11):2149-2160. 14. Gonsalves N, Pollicarpio-Nicolas M, Zhang Q, et al. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc. 2006 Sep;64(3):313-319. 15. Collins M. Histopathology of eosinophilic esophagitis. Dig Dis. 2014;32:(1-2)68-73. 16. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA; American College of Gastroenterology. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679-692. 17. Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018;154(suppl 4):1-16. 18. Lucendo AJ, Arias Á, Molina-Infante J. Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(1):13-22. 19. Greuter T, Godat A, Ringel A, et al. Effectiveness and safety of high- vs low-dose swallowed topical corticosteroids for maintenance treatment of eosinophilic esophagitis: a multicenter observational study. Clin Gastroenterol Hepatol. 2021;19(12):2514–2523.e2.

EoE REQUIRES A LONG-TERM MANAGEMENT APPROACH THAT FOCUSES ON 3 KEY AREAS: SYMPTOMS, HISTOLOGY, ENDOSCOPIC APPEARANCE¹

Symptoms are one part of diagnosing and monitoring EoE, and can vary between patients and across age groups²

Children  (≤11 years)

Adult and adolescent (≥12 years)

Symptoms often progress from feeding difficulties in young children to dysphagia and food impaction in adolescents and adults.

As EoE progresses, dysphagia can worsen, and food impactions may require ER visits³

Studies show that approximately 54% of patients who had esophageal biopsies collected at the time of food impaction removal had EoE^5,6

Even in the absence of symptoms, the underlying type 2 inflammation can still be present⁷

Adaptive behaviors can mask EoE symptoms and delay diagnosis, management, and disease surveillance^8,9

Consider asking your patients and caregivers questions to uncover these common adaptive behaviors¹¹

Children may exhibit different types of adaptive behaviors than adult patients¹¹

Histology can reveal eosinophilic infiltrate as well as other abnormalities¹

Biopsy Sensitivity for EoE Diagnosis in Adult Patients (N=66)^14,a

Healthy tissue⁴

Select EoE tissue abnormalities, indicative of fibrosis¹⁵

Endoscopic appearance can reveal inflammatory and fibrostenotic structural changes in the esophagus^1,16,17

EoE requires long-term comprehensive management

Assess treatments to confirm response and disease control

To maintain long-term control of EoE, ACG recommends:

Staying on a maintenance treatment
even after achieving initial response or a state of remission^1,4

Regular monitoring to ensure continued response
and confirm there hasn’t been a recurrence of symptoms, inflammation,  
or structural changes in the esophagus^1,4

Symptoms

EoE REQUIRES A LONG-TERM MANAGEMENT APPROACH THAT FOCUSES ON 3 KEY AREAS: SYMPTOMS, HISTOLOGY, ENDOSCOPIC APPEARANCE1

Symptoms are one part of diagnosing and monitoring EoE, and can vary between patients and across age groups2

Children (≤11 years)

Adult and adolescent (≥12 years)

Symptoms often progress from feeding difficulties in young children to dysphagia and food impaction in adolescents and adults.

As EoE progresses, dysphagia can worsen, and food impactions may require ER visits3

Studies show that approximately 54% of patients who had esophageal biopsies collected at the time of food impaction removal had EoE5,6

Even in the absence of symptoms, the underlying type 2 inflammation can still be present7

Adaptive behaviors can mask EoE symptoms and delay diagnosis, management, and disease surveillance8,9

Consider asking your patients and caregivers questions to uncover these common adaptive behaviors11

Children may exhibit different types of adaptive behaviors than adult patients11

Histology can reveal eosinophilic infiltrate as well as other abnormalities1

Biopsy Sensitivity for EoE Diagnosis in Adult Patients (N=66)14,a

Healthy tissue4

Select EoE tissue abnormalities, indicative of fibrosis15

Endoscopic appearance can reveal inflammatory and fibrostenotic structural changes in the esophagus1,16,17

EoE requires long-term comprehensive management

Assess treatments to confirm response and disease control

To maintain long-term control of EoE, ACG recommends:

Staying on a maintenance treatment even after achieving initial response or a state of remission1,4

Regular monitoring to ensure continued response and confirm there hasn’t been a recurrence of symptoms, inflammation, or structural changes in the esophagus1,4

EoE REQUIRES A LONG-TERM MANAGEMENT APPROACH THAT FOCUSES ON 3 KEY AREAS: SYMPTOMS, HISTOLOGY, ENDOSCOPIC APPEARANCE¹

Symptoms are one part of diagnosing and monitoring EoE, and can vary between patients and across age groups²

Children  (≤11 years)

Adult and adolescent (≥12 years)

As EoE progresses, dysphagia can worsen, and food impactions may require ER visits³

Studies show that approximately 54% of patients who had esophageal biopsies collected at the time of food impaction removal had EoE^5,6

Even in the absence of symptoms, the underlying type 2 inflammation can still be present⁷

Adaptive behaviors can mask EoE symptoms and delay diagnosis, management, and disease surveillance^8,9

Consider asking your patients and caregivers questions to uncover these common adaptive behaviors¹¹

Children may exhibit different types of adaptive behaviors than adult patients¹¹

Histology can reveal eosinophilic infiltrate as well as other abnormalities¹

Biopsy Sensitivity for EoE Diagnosis in Adult Patients (N=66)^14,a

Healthy tissue⁴

Select EoE tissue abnormalities, indicative of fibrosis¹⁵

Endoscopic appearance can reveal inflammatory and fibrostenotic structural changes in the esophagus^1,16,17

Staying on a maintenance treatment
even after achieving initial response or a state of remission^1,4

Regular monitoring to ensure continued response
and confirm there hasn’t been a recurrence of symptoms, inflammation,  
or structural changes in the esophagus^1,4