Eosinophilic esophagitis: diagnosis & treatment

Confirms EoE (≥15 eos/hpf + symptoms, alternatives excluded), then the full current treatment set including dupilumab and a step-up elimination diet. Links the EoE peak-eosinophil calculator.

Evidence tier: Guideline-derived.

Decision points

  • Histology + clinical picture?

Do-not-miss pitfalls

  • Do not diagnose EoE on peripheral eosinophilia alone, it is a tissue diagnosis.
  • Do not reassure on symptom improvement without confirming histologic response.
  • Do not use broad IgE panels as the basis for an EoE elimination diet (EoE is non-IgE-mediated).
  • Do not perform dilation without also addressing the underlying eosinophilic inflammation.
  • Do not apply the obsolete PPI-trial-to-diagnose algorithm, PPIs are a treatment.

Evidence & citations

  1. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis (AGREE). Gastroenterology. 2018;155(4):1022-1033. PMID 30009819
  2. Hirano I, Moy N, Heckman MG, et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis (EREFS). Gut. 2013;62(4):489-495. PMID 22619364
  3. Kliewer KL, Gonsalves N, Dellon ES, et al. One-food versus six-food elimination diet therapy for eosinophilic oesophagitis: a randomised controlled trial. Lancet Gastroenterol Hepatol. 2023;8(5):408-421. PMID 36863390
  4. Dupilumab (Dupixent) FDA approval for EoE: May 2022 (≥12 yr, ≥40 kg), expanded Jan 2024 (ages 1-11, ≥15 kg). Budesonide oral suspension (Eohilia) FDA approval Feb 2024. FDA approvals

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.