Criteria

Consensus diagnostic guidelines for eosinophilic oesophagitis​[1][2][3][4][80][83]

These criteria are based on guidelines and include clinical and pathological criteria:

  • Symptoms of oesophageal dysfunction. This is the clinical criterion. Symptoms include dysphagia, food impaction, heartburn, chest pain, regurgitation, vomiting. In children, abdominal pain and failure to thrive are also seen.

  • ≥15 eosinophils per high-power microscopy field (or ≥15 eosinophils per 0.3 mm²) on oesophageal biopsy. This is the pathological criterion. The eosinophilia must be isolated to the oesophagus.

  • Exclusion of other causes. Other causes of systemic and oesophageal eosinophilia must be evaluated. Gastro-oesophageal reflux disease (GORD) is the principal disease entity confused with EoO.

  • The relationship between GORD and EoO may be bi-directional. Patients with EoO achieving clinical and/or histological remission on proton-pump inhibitor (PPI) therapy are part of the EoO continuum. Nonetheless, they may also have an element of GORD, and they may have acid hypersensitivity as a consequence of their EoO, accounting for part of their response to the PPI.

Consensus clinical severity index for eosinophilic oesophagitis​[98]

These criteria reflect EoO's key clinicopathological features in three domains:

Symptoms and complications

  • Symptoms

    • Weekly (1 point)

    • Daily (2 points)

    • Multiple times per day or disrupting social functioning (4 points)

  • Complications

    • Food impaction with accident and emergency department visit or endoscopy (patient ≥18 years) (2 points)

    • Food impaction with accident and emergency department visit or endoscopy (patient <18 years) (4 points)

    • Hospitalisation due to EoO (4 points)

    • Oesophageal perforation (15 points)

    • Malnutrition with body mass <5th percentile or decreased growth trajectory (15 points)

    • Persistent inflammation requiring elemental formula, or systemic corticosteroid, or immunomodulatory treatments (including biologicals, azathioprine/mercaptopurine, or other immune-targeted treatments) (15 points)

Inflammatory features

  • Endoscopy (oedema, furrows, and/or exudates)

    • Localised (1 point)

    • Diffuse (2 points)

  • Histology

    • 15-60 eosinophils/high-power field (1 point)

    • >60 eosinophils/high-power field (2 points)

    • Note UK guidelines recommend using 0.3 mm² instead of high-power field (the standard high-power field is 0.3 mm²)

Fibrostenotic features

  • Endoscopy (rings, strictures)

    • Present, but endoscope passes easily (1 point)

    • Present, but requires dilation or a snug fit when passing a standard endoscope (2 points)

    • Cannot pass standard upper endoscope; repeated dilations (in an adult ≥18 years); or any dilation (in a child <18 years) (15 points)

  • Histology

    • Basal zone hyperplasia or lamina propria (LP) fibrosis (or dyskeratotic epithelial cell/surface epithelial alteration if no LP) (2 points)

Eosinophilic oesophagitis severity: 1-6 points = mild; 7-14 points = moderate; ≥15 points = severe

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