Advances in the endoscopic evaluation of eosinophilic esophagitis

Purpose of review: Endoscopic detection of mucosal healing has emerged as a primary therapeutic endpoint in inflammatory bowel disease. Endoscopically identified esophageal features are increasingly being utilized in diagnostic and therapeutic decisions in eosinophilic esophagitis (EoE). Recent findings: Studies over the past 5 years have demonstrated the validity, accuracy, and clinical relevance of a systematic, endoscopic assessment of esophageal abnormalities in EoE. The initial severity of EoE endoscopic findings has important implications with regard to therapeutic options, including the need for dilations, and may be an important predictor of the effectiveness of medical therapies. Moreover, endoscopic parameters can serve as reliable therapeutic endpoints that substantiate the interpretation of currently used metrics of patient-reported symptom outcomes and eosinophil density. Finally, tools such as endosonography and functional luminal imaging probe are providing fundamental insights regarding the remodeling consequences of EoE that are the central determinants of disease complications. Summary: Endoscopic features are having an increasing role in the diagnosis, phenotype characterization, and choice of therapies for EoE. Comprehensive assessment of therapeutics in EoE should ideally incorporate symptoms, histology, and endoscopic healing.