Sato et al recommend a process for the diagnosis of eosinophilic disorders of the esophagus. The authors are from Saiseikai Niigata Daini Hospital and Niigata University in Japan.
Patient selection: esophageal symptoms
Parameters:
(1) endoscopic appearance
(2) eosinophils in epithelium or subepithelium
(3) peristalsis on manometry
(4) serum IgE concentrations
(5) eosinophils in muscularis by peroral eosphageal muscle (POEM) biopsy or EUS-FNA
(6) exclusion of other causes of esophageal eosinophilia (parasitic infection, GERD)
Endoscopic features of an eosinophilic disorder:
(1) longitudinal furrows
(2) white plaques
(3) fixed rings
(4) compressed lumen
General features:
(1) endoscopic features
(2) elevated serum IgE concentration
(3) exclusion of alternative explanations for eosinophilia
Categories of eosinophilic esophageal disorders:
(1) eosinophilic esophagitis
(2) subepithelial eosinophilic esophagitis
(3) eosinophilic esophageal myositis
Eosinophilic inflammation is a peak eosinophil count >= 15 per high power field (hpf)
Eosinophilic esophagitis: intra-mucosal eosinophils >= 15 per hpf
Subepithelial eosinophilic esophagitis: eosinophils >= 15 per hpf primarily in subepithelium
Eosinophilic esophageal myositis:
(1) abnormal manometry (including jackhammer and nutcracker esophagus)
(2) no eosinophils in mucosa or subepithelium
(3) eosinophils in muscle layer by POEM-b or EUS-FNA
