Esophagitis

Treat inability to clear an esophageal food bolus as an endoscopic problem: flexible upper endoscopy is recommended to remove impacted food. After extraction, inspect for rings, narrowing, mucosal injury, and other structural disease; obtain or arrange esophageal biopsy when EoE is a diagnostic consideration. PubMedPubMedEosinophilic Esophagitis - StatPearls - NCBI Bookshelf

For esophageal dysphagia outside the immediate food-impaction setting, upper endoscopy with biopsy is the recommended first-line test. It evaluates mucosal injury and structural lesions while detecting esophagitis due to reflux, infection, pills, or eosinophilia before pursuing a motility diagnosis. Gastroenterology+1GastroenterologyEsophageal Motility DisordersGastroenterologyEsophageal Motility Disorders: Current Approach to ...

Do not use a normal-appearing esophagus to exclude EoE. When dysphagia, recurrent food impaction, or an atopic phenotype raises suspicion, obtain esophageal biopsies during endoscopy because histology establishes the eosinophilic inflammatory pattern. EoE requires at least 15 eosinophils per high-power field and exclusion of identified secondary causes of esophageal eosinophilia. PubMedPubMedTHE SEVERITY OF REDUCED ESOPHAGEAL DISTENSIBILITY PARALLELS EOSINOPHILIC ESOPHAGITIS DISEASE DURATION - PMC

A distal peptic stricture favors chronic reflux-mediated ulcerative esophagitis and scarring. PPI therapy has reduced the incidence of peptic strictures and is central to healing and maintenance of reflux esophagitis; persistent or recurrent dysphagia still requires structural reassessment rather than escalation based on symptoms alone. PubMedPubMedTreatment of GERD Complications (Barrett’s, Peptic Stricture) and Extraesophageal Syndromes - PMC

EoE is a chronic type 2 inflammatory disease driven by a T-helper 2 response to food antigens in contact with esophageal mucosa. Its clinically important trajectory is from inflammation toward fibrostenotic remodeling, with strictures, luminal narrowing, and a need for dilation in some patients. ScienceDirect+1ScienceDirectMedical and dietary management of eosinophilic esophagitis - ScienceDirectGastroenterologyDiagnosis and Treatment of Eosinophilic Esophagitis

Infectious, pill-related, radiation-associated, malignant, traumatic or surgical, alcohol-related, and motility-associated esophageal injury are alternative etiologies of esophagitis. Endoscopy with biopsy is the practical discriminator when symptoms or mucosal findings do not fit uncomplicated reflux disease, because it permits direct assessment of the lesion and exclusion of eosinophilic inflammation. ScienceDirect+2ScienceDirectPinaverium - an overview | ScienceDirect TopicsGastroenterologyEsophageal Motility DisordersGastroenterologyEsophageal Motility Disorders: Current Approach to ...

If dysphagia persists after endoscopy and biopsies have excluded mucosal and structural causes, do not continue an esophagitis-directed pathway without reassessment. Esophageal motility disorders require a separate diagnostic approach after endoscopic exclusion of structural and mucosal disease. Gastroenterology+1GastroenterologyEsophageal Motility DisordersGastroenterologyEsophageal Motility Disorders: Current Approach to ...

Choose initial EoE treatment with shared decision-making among PPI therapy, swallowed topical corticosteroids, and dietary elimination; guidelines and practice patterns recognize these as established therapeutic options, although their sequencing differs across guidance. Nature+1NatureReal world treatment patterns in patients with eosinophilic esophagitis in Japan | Scientific ReportsScienceDirectClinical guidance for the use of dupilumab in eosinophilic esophagitis A PPI trial of 20 to 40 mg orally once or twice daily is a reasonable first-line option. PubMedPubMedEosinophilic Esophagitis - StatPearls - NCBI Bookshelf

After symptomatic improvement on a PPI, repeat endoscopy with esophageal biopsies to document histologic response. If repeat biopsies show no eosinophils, the clinical framework includes acid-mediated GERD with eosinophilia or PPI-responsive EoE; persistent symptoms and eosinophilia after PPI support an immune-mediated EoE pathway. PubMedPubMedEosinophilic Esophagitis - StatPearls - NCBI Bookshelf

For EoE with persistent disease after PPI therapy, swallowed—not inhaled—topical corticosteroid treatment for 8 weeks is a recommended approach. U.S. options described include fluticasone oral suspension 880 to 1,760 mcg/day or budesonide 1 to 2 mg/day. PubMedPubMedEosinophilic Esophagitis - StatPearls - NCBI Bookshelf In a randomized trial, budesonide oral suspension 2 mg twice daily produced histologic and clinical remission more often than placebo at 12 weeks, with histologic remission reported in 53.1% versus 1.0%. PubMedPubMedOptimal Assessment, Treatment, and Monitoring of Adults with Eosinophilic Esophagitis: Strategies to Improve Outcomes

Use dietary elimination when a patient prefers a nonpharmacologic anti-inflammatory approach and can sustain the dietary burden. Dietary therapy requires adherence assessment and structured reintroduction to identify triggers; motivation, age, and available educational resources materially affect feasibility. PubMed+1PubMedRecent advances in the treatment of eosinophilic esophagitisPubMedEfficacy of Dupilumab on Facilitated Food Reintroduction in Eosinophilic Esophagitis. - Abstract

Consider dupilumab for patients needing targeted therapy after inadequate conventional treatment or when treatment selection favors a biologic strategy. Dupilumab is FDA-approved for EoE in patients aged 12 years or older weighing at least 40 kg. ccjmccjmEosinophilic esophagitis: promising therapy, biomarkers, and assessment tools | Cleveland Clinic Journal of medicine In the LIBERTY-EoE-TREET trial, dupilumab 300 mg subcutaneously weekly achieved histologic remission below 6 eosinophils per high-power field in 59.9% versus 5.1% of placebo recipients in one trial part and 58.8% versus 6.3% in another. PubMedPubMedRecent advances in the treatment of eosinophilic esophagitis

Offer esophageal dilation for clinically significant EoE stricture or narrowing causing obstructive symptoms, aiming for a luminal diameter of 15 to 18 mm. PubMedPubMedRecent advances in the treatment of eosinophilic esophagitis Dilation is generally safe, and perforation and bleeding are described as very rare, but it must be performed with recognition that EoE mucosa may be fragile. PubMedPubMedRecent advances in the treatment of eosinophilic esophagitis

Pair dilation with pharmacologic or dietary anti-inflammatory therapy because dilation does not alter EoE pathogenesis or control eosinophilic inflammation. PubMed+1PubMedManaging eosinophilic esophagitis: challenges and solutions - PMCPubMedRecent advances in the treatment of eosinophilic esophagitis Although controlling inflammation before dilation is ideal, timing is not firmly established and clinically important obstruction may require mechanical treatment before full anti-inflammatory response is achieved. PubMedPubMedRecent advances in the treatment of eosinophilic esophagitis

For peptic strictures, reflux suppression remains necessary after mechanical treatment because chronic ulcerative reflux injury is the mechanism of scar formation. Widespread use of PPI healing and maintenance therapy has been associated with a decline in peptic-stricture incidence. PubMedPubMedTreatment of GERD Complications (Barrett’s, Peptic Stricture) and Extraesophageal Syndromes - PMC

For EoE treated with PPI, repeat endoscopy with biopsies after symptomatic improvement to determine whether eosinophilic inflammation has resolved. PubMedPubMedEosinophilic Esophagitis - StatPearls - NCBI Bookshelf This prevents misclassification of persistent eosinophilia as controlled disease and determines whether to continue a PPI-centered strategy or move to swallowed topical steroid, dietary elimination, or biologic therapy. PubMed+2PubMedEosinophilic Esophagitis - StatPearls - NCBI BookshelfPubMedRecent advances in the treatment of eosinophilic esophagitisScienceDirectClinical guidance for the use of dupilumab in eosinophilic esophagitis

If symptoms persist despite an apparently adequate EoE regimen, review diagnostic histology, exclusion of alternative causes, treatment dose and duration, and adherence before escalation. In particular, dietary treatment failure cannot be interpreted without confirming actual avoidance of targeted foods for an adequate interval. PubMedPubMedManaging eosinophilic esophagitis: challenges and solutions - PMC

Long symptom duration and diagnostic delay are associated with reduced esophageal distensibility in EoE, reinforcing the need to investigate recurrent dysphagia or food impaction rather than allowing prolonged untreated obstructive disease. PubMedPubMedTHE SEVERITY OF REDUCED ESOPHAGEAL DISTENSIBILITY PARALLELS EOSINOPHILIC ESOPHAGITIS DISEASE DURATION - PMC When endoscopy and biopsies do not explain dysphagia, redirect the workup to esophageal motility disorders. Gastroenterology+1GastroenterologyEsophageal Motility DisordersGastroenterologyEsophageal Motility Disorders: Current Approach to ...