What is the role of upper endoscopy in the workup of eosinophilic esophagitis (EoE)?

Updated: Jan 03, 2020
  • Author: Nina Tatevian, MD, PhD, FCAP; Chief Editor: Nirag C Jhala, MD, MBBS  more...
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Upper endoscopy for mucosal abnormalities is an integral part of the diagnostic workup in suspected eosinophilic esophagitis (EoE). The endoscopic mucosal changes may be seen through the entire length of the esophagus. The mucosal abnormalities are well described, but none of the features is pathognomonic for EoE and can be seen in other pathological conditions. [2]

The presence of a normal esophageal mucosa on endoscopy does not rule out EoE. [45]

A combination of mucosal abnormalities may be seen, and features vary depending on the stage of the disease. In EoE with active inflammation, the endoscopic findings include diminished vascular pattern, mucosal linear furrows, thick mucosa, and surface exudates. In chronic disease with tissue remodeling, the major endoscopic features seen are fixed rings (also referred to as concentric rings, corrugated esophagus, corrugated rings, ringed esophagus, trachealization), furrows (vertical lines or longitudinal furrows), edema (decreased vascular markings or mucosal pallor), exudates (white spots or plaques), and strictures. Crepe paper esophagus is a minor endoscopic feature due to mucosal fragility. [2, 37, 46, 47]


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