Symptom-based diagnostic approach for eosinophilic esophagitis
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REVIEW
Symptom-based diagnostic approach for eosinophilic esophagitis Yasuhiro Fujiwara1
Received: 29 April 2020 / Accepted: 5 July 2020 Ó The Author(s) 2020
Abstract The prevalence of eosinophilic esophagitis (EoE) has been increasing in Japan. Although the diagnosis of EoE is based on simple criteria that include the presence of esophageal symptoms and esophageal eosinophilia on biopsies, there are several important issues associated with the diagnostic approach. Following an extensive literature search, the symptoms of 886 EoE cases in Japanese adults were analyzed and divided into three categories as follows: (1) typical symptoms, such as dysphagia (53%); (2) other upper GI symptoms (40%); and (3) no symptoms found during screening or medical examination, i.e., ‘‘asymptomatic esophageal eosinophilia’’ (19%). The diagnostic approach was reviewed according to these categories as well as according to the presence or absence of esophageal eosinophilia. The present manuscript describes the current therapeutic strategy of EoE and ultimately proposes a symptom-based diagnostic approach for EoE. Keywords Eosinophilic esophagitis Esophageal eosinophilia Dysphagia
Introduction Eosinophilic esophagitis (EoE) is a chronic antigen-mediated allergic disease of the esophagus in adults and children [1–3]. EoE is commonly found in Western countries but is relatively rare in Asia [4, 5]; nevertheless, the prevalence
& Yasuhiro Fujiwara [email protected] 1
Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, Japan
of EoE has been increasing in Japan [6–8]. Recent European guidelines [2] and International consensus (AGREE) [3] have demonstrated that the diagnostic criteria of EoE include the presence of esophageal symptoms and esophageal eosinophil (eos) infiltration, defined as intraepithelial eosinophil infiltration of C 15 eos/high-power field (hpf). Although the diagnosis of EoE is not clinically challenging, several important issues require consideration in the diagnostic approach. Most patients in Western countries complain of typical symptoms such as dysphagia and food impaction [9, 10]; however, the prevalence of symptom variations in Japanese adult patients with EoE has not yet been elucidated. The current study analyzed the prevalence of symptoms in Japanese patients with EoE, categorized the symptoms, provided a review of the diagnostic approach, briefly explained the current therapeutic strategies, and finally proposed a symptom-based diagnostic approach. Although the current criteria require the presence of esophageal symptoms [1–3], asymptomatic cases have been reported in Japan, particularly during medical examinations [11–14]. Therefore, asymptomatic cases, formally known as ‘‘asymptomatic esophageal eosinophilia,’’ have been included in this review as asymptomatic EoE.
Prevalence of symptom variations Clinical studies and case reports of EoE in Japanese adults were identified by searching PubMed, Ichushi, Shoreikun, and UMIN
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