Diagnosis Insights into Eosinophilic Esophagitis
Intro
Eosinophilic esophagitis (EoE) is not just a mouthful to say; it represents a significant, growing concern in the realm of gastroenterology. This chronic inflammatory condition primarily affects the esophagus and is characterized by a substantial infiltration of eosinophils. Understanding how to diagnose EoE is crucial for both clinicians and patients since timely recognition can lead to effective management and improved patient outcomes. This article seeks to unpack the complexities related to the diagnosis of EoE, incorporating clinical presentations, diagnostic criteria, and methodologies used.
Methodology
Study Design
The approach to understanding EoE diagnosis is structured around systematic reviews and clinical studies. Researchers conduct cross-sectional studies focusing on demographics, symptomatology, and histopathological findings associated with EoE. Data is often collected from a variety of clinical settings to ensure a comprehensive overview of how this condition is diagnosed across different populations.
Data Collection Techniques
In the quest to understand the diagnosis of EoE, several techniques are utilized to gather data:
- Patient Interviews: Gathering detailed patient histories regarding symptoms such as dysphagia, food impaction, and reflux.
- Endoscopic Evaluations: Performing esophagogastroduodenoscopy (EGD) with biopsy to assess eosinophil counts in esophageal tissue.
- Histological Analysis: Examining biopsy samples under a microscope to confirm the eosinophilic infiltration.
- Clinical Guidelines Review: Evaluating existing diagnostic criteria set by professional organizations like the American College of Gastroenterology.
"Diagnosing Eosinophilic Esophagitis requires a multifaceted approach, combining patient reports, endoscopic findings, and histological confirmation."
Discussion
Interpretation of Results
After data collection, results are analyzed to determine patterns that help in establishing a diagnosis. The presence of more than 15 eosinophils per high-power field in esophageal biopsies is typically used as a primary diagnostic criterion. Correlating this histological finding with clinical symptoms aids in the precise identification of EoE.
Limitations of the Study
Despite the advancements in diagnostic methods, several limitations exist. One challenge is the overlap of symptoms with other esophageal disorders such as gastroesophageal reflux disease (GERD). Furthermore, the variability in eosinophil counts can sometimes lead to misinterpretation of results, complicating the diagnosis further.
Future Research Directions
Future directions in EoE research should focus on improving diagnostic specificity. Exploring biomarker identification and developing non-invasive diagnostic methods could enhance diagnosis accuracy. Additionally, more studies are needed to analyze the long-term treatment outcomes related to different diagnostic strategies.
Understanding EoE and its diagnosis is intricate yet vital. By improving the diagnostic protocols, clinicians can enhance their approach to management, ultimately benefiting their patients.
Prologue to Eosinophilic Esophagitis
The topic of eosinophilic esophagitis (EoE) is critical in understanding chronic disorders affecting the esophagus. EoE is marked by chronic inflammation and eosinophilic infiltration, which can lead to significant complications if not diagnosed timely. Knowledge of EoE ensures that healthcare professionals can distinguish it from other gastrointestinal conditions. This enhances patient outcomes through targeted interventions and effective management strategies.
EoE represents a relatively novel entity in gastroenterology, with its recognition increasing over the years. The importance of early diagnosis cannot be overstated, as patients often struggle with symptoms that may mimic other disorders. A comprehensive understanding of EoE helps clinicians appreciate the disease dynamics, which can lead to improved diagnostic pathways.
Definition and Classification
Eosinophilic esophagitis is defined as a chronic immune-mediated condition characterized by an elevated eosinophil count in the esophagus. Its classification can vary based on various features such as the age of onset, symptomatology, and associated conditions. EoE can typically be categorized into different subtypes, including:
- Allergic EoE: Often triggered by specific food allergens.
- Non-allergic EoE: Not associated with identifiable allergens, may relate to other factors such as environmental exposures.
Understanding these classifications allows for tailored treatment approaches.
Epidemiology of EoE
The epidemiology of eosinophilic esophagitis reveals rising prevalence rates, particularly in Western countries. Research indicates that EoE affects both adults and children, though there is a notably higher incidence in males. Important points in the epidemiology include:
- Incidence Rates: Studies show prevalence rates of EoE estimated at around 10 to 30 per 100,000 people.
- Age of Diagnosis: The condition frequently manifests during childhood but can also be diagnosed in adulthood, indicating diverse demographic impacts.
The increase in awareness and diagnostic capabilities likely contributes to the rising incidence, prompting researchers to investigate further into genetic, environmental, and dietary factors that may trigger or exacerbate eosinophilic esophagitis.
Understanding these elements provides a broader perspective on the condition, guiding clinicians in their approaches to treatment and management.
Clinical Manifestations of EoE
Understanding the clinical manifestations of eosinophilic esophagitis (EoE) is essential in diagnosing this condition. The symptoms vary widely among individuals but tend to be indicative of an underlying inflammation. Recognizing these manifestations aids in timely intervention, which is crucial for effective management. In this section, we will delve into the symptomatic presentation and complications related to EoE.
Symptomatic Presentation
The symptomatic presentation of EoE can be diverse and sometimes perplexing. Some of the common symptoms include:
- Dysphagia: Difficulty swallowing is one of the most prevalent symptoms, which can lead to a significant impact on a patient's quality of life.
- Food Impaction: This occurs when food becomes lodged in the esophagus, causing discomfort or distress.
- Chest Pain: Patients may expereince non-cardiac chest pain, which could mislead clinicians if not properly evaluated.
- Nausea or Vomiting: These symptoms can often lead to misdiagnosis or confusion with other gastrointestinal disorders.
Certain patient populations, particularly children, may exhibit different signs, often related to feeding difficulties. It is imperative to consider the spectrum of symptoms when assessing a patient for EoE.
Furthermore, the individual presentation can regularly overlap with other conditions, making it necessary for clinicians to maintain a high index of suspicion for EoE when faced with these symptoms.
Complications Related to EoE
The complications arising from EoE are significant and can affect the patient's overall health. These include:
- Stricture Formation: Chronic inflammation leads to a narrowing of the esophagus, necessitating surgical interventions in severe cases.
- Esophageal Perforation: Although rare, this is a life-threatening condition that can result from severe EoE. Immediate medical attention is crucial.
- Reduced Quality of Life: The associated symptoms, such as pain and difficulty swallowing, can lead to psychological distress.
Complications like strictures may necessitate endoscopic dilation, emphasizing the ongoing care required for EoE.
It is essential for healthcare providers to recognize these complications early. Management strategies can then be implemented promptly to mitigate risks and improve the patient's overall well-being. Understanding these clinical manifestations is critical, not only for diagnosis but also for tailoring effective treatment plans that address both the symptoms and their complications.
Pathophysiology of Eosinophilic Esophagitis
Understanding the pathophysiology of Eosinophilic Esophagitis (EoE) is pivotal for grasping its complex nature. It connects clinical symptoms to underlying biological mechanisms. Detailed knowledge about how EoE develops can enhance diagnostic accuracy and influence treatment strategies. Particularly, the interplay between the immune system, allergens, and environmental factors must be examined closely, as they play critical roles in the chronic inflammation seen in EoE.
Immune Response and Eosinophil Activity
Eosinophils are a distinct type of white blood cell that function prominently in the immune response. In EoE, these cells become activated and migrate into the esophageal tissue, leading to inflammation. This process often occurs in reaction to various triggers, such as foods or allergens. Once activated, eosinophils release inflammatory mediators that contribute to tissue damage and esophageal dysfunction.
The activation of eosinophils is typically mediated by the T (T-helper 2) immune response. This pathway is essential, as it drives the allergic response characterized by the secretion of cytokines like IL-4, IL-5, and IL-13. Each of these substances enhances eosinophil recruitment, survival, and activation in the esophagus.
"Eosinophilic infiltration is not only a hallmark of EoE but also a key factor in its inflammatory processes."
Furthermore, local epithelial cells in the esophagus may respond to eosinophilic inflammation by altering their function, leading to dysphagia and other symptoms associated with the disorder. The role of eosinophil activity is, therefore, central to both the diagnosis and management of EoE. Understanding this immune response can inform healthcare providers on how best to approach treatment options that attenuate the chronic inflammation and related symptoms.
Role of Allergens and Environmental Factors
The role of allergens and environmental factors in EoE cannot be overstated. Multiple studies implicate specific food allergens in exacerbating the condition. Common offenders include dairy, wheat, soy, nuts, and seafood. The exact mechanism through which these allergens contribute to disease advancement involves an abnormal immune response that leads to eosinophil activation, making the identification of triggers vital for effective management.
Environmental factors such as pollution or smoke exposure may also influence the severity of EoE. These elements can exacerbate the inflammatory process within the esophagus, complicating symptomatology.
Researchers emphasize the importance of avoiding recognized triggers, which can lead to improved patient outcomes. It is critical for clinicians to consider both dietary and environmental influences when assessing individuals for EoE.
In summary, the pathophysiology of EoE encompasses an intricate dance between immune responses, eosinophil activities, and the impacts of allergens and environmental conditions. A comprehensive understanding of these aspects is essential for accurate diagnosis and targeted interventions.
Diagnosis of Eosinophilic Esophagitis
The diagnosis of Eosinophilic Esophagitis (EoE) is pivotal because it sets the foundation for effective management and treatment. Misdiagnosis or delayed diagnosis can lead to unnecessary suffering and complications. Understanding how to properly diagnose this condition is essential not only for clinicians but also for patients who experience chronic symptoms.
In this section, we will explore several aspects of diagnosing EoE, including the initial clinical assessment, endoscopic evaluations, and histopathological examinations. Each of these elements plays a critical role in forming a comprehensive understanding of the patient's condition.
Initial Clinical Assessment
The first step in diagnosing EoE involves a thorough clinical assessment. Physicians commonly gather a detailed history of symptoms, dietary habits, and any prior allergies. Patients usually present with symptoms such as dysphagia, food impaction, and chest pain. It can be challenging at this stage because these symptoms can be nonspecific and overlap with other gastrointestinal conditions.
During this assessment, clinicians also consider:
- Family History: A background of allergic conditions in the family may indicate a higher risk for EoE.
- Physical Examination: This might reveal signs of malnutrition or a failure to thrive, particularly in pediatric patients.
- Patient's Age and Gender: EoE is often diagnosed in young males, which may guide clinicians in their evaluation.
This initial assessment is crucial in determining the need for further diagnostic investigations.
Endoscopic Evaluation
Once the clinical symptoms align with a potential diagnosis of EoE, the clinician may recommend an endoscopic evaluation. This procedure allows for direct visualization of the esophagus and identification of any esophageal abnormalities. During endoscopy, several key observations can be made:
- Esophageal Rings and Strictures: Narrowing of the esophagus can be noted, often referred to as "feline esophagus."
- White Exudates: These may indicate eosinophilic infiltration or food debris, common in EoE.
- Linear Furrows: Longitudinal lines may be prominent, adding further evidence of esophageal inflammation.
Biopsies taken during endoscopy are vital for confirming the diagnosis. The tissue samples should be adequately analyzed for eosinophilic infiltration.
Histopathological Examination
Histopathological examination is the gold standard for diagnosing EoE. Biopsies obtained during the endoscopy undergo microscopic evaluation. This analysis focuses on measuring the eosinophil count in the esophageal tissue. A finding of more than 15 eosinophils per high-power field is typically indicative of EoE.
In addition to eosinophil counts, the histopathological evaluation can reveal other important features:
- Basal Cell Hyperplasia: Indicates a response to inflammation over time.
- Decreased Epithelium Integrity: This might demonstrate chronic inflammation affecting the esophageal lining.
Collectively, the evaluation of biopsy specimens assists in distinguishing EoE from other esophageal disorders, providing a conclusive diagnosis.
Accurate diagnosis of EoE is crucial for effective management. Delays or incorrect assessments can significantly impact a patient's quality of life.
Diagnostic Criteria for EoE
The diagnostic criteria for Eosinophilic Esophagitis (EoE) play a vital role in identifying this complex condition. Accurate diagnosis is essential not only for effective treatment but also for differentiating EoE from other esophageal disorders. EoE is characterized by eosinophilic infiltration in the esophageal epithelium, which necessitates a precise and systematic approach to diagnosis.
Revised Consensus Guidelines
The revised consensus guidelines provide a framework for the diagnosis of EoE, ensuring that clinicians can effectively assess and confirm cases of this condition. These guidelines emphasize several key points:
- Eosinophil Count: A minimum of 15 eosinophils per high power field in esophageal biopsies is usually required for diagnosis.
- Symptoms: The presence of symptoms such as dysphagia, food impaction, or esophageal dysfunction is critical for establishing the need for further evaluation.
- Exclusion of Other Conditions: A thorough differential diagnosis process must be conducted to rule out other causes of eosinophilia or esophageal symptoms, such as gastroesophageal reflux disease (GERD).
Following these guidelines ensures that EoE is recognized early in its course, which can improve patient outcomes significantly.
Differential Diagnosis Considerations
Differential diagnosis remains a critical aspect of managing EoE. Several conditions can present with similar symptoms or eosinophilic infiltration, making accurate diagnosis challenging. Key considerations include:
- Gastroesophageal Reflux Disease (GERD): GERD can mimic many of the symptoms associated with EoE. However, the presence of eosinophils is typically absent or lower in GERD cases.
- Infectious Esophagitis: Conditions like candidiasis can lead to eosinophilic infiltration, especially in immunocompromised patients. Identifying the cause is essential for treatment.
- Esophageal Stricture or Other Structural Abnormalities: These can result in similar dysphagia symptoms and require imaging studies or endoscopic evaluations for clarity.
"Effective diagnosis involves a comprehensive evaluation and clinical judgement, acknowledging the interplay among various potential causes."
To improve diagnostic accuracy, a multi-faceted approach that includes patient history, symptom assessment, histological examination, and careful consideration of all differential diagnoses is essential. This leads to timely and appropriate management, alleviating patients' symptoms and improving their quality of life.
Imaging and Additional Testing
The realm of imaging and additional testing plays a pivotal role in the comprehensive diagnosis of eosinophilic esophagitis (EoE). While the diagnosis primarily relies on clinical evaluation and histopathological findings, radiologic imaging and laboratory tests can provide supportive evidence, especially when the clinical presentation is ambiguous. These diagnostic modalities serve to confirm eosinophilic infiltration and rule out other conditions that might mimic EoE, ensuring a precise diagnosis.
Role of Radiologic Imaging
Radiologic imaging is essential when exploring suspected cases of EoE. The use of high-resolution imaging techniques like barium swallow studies can reveal abnormalities that may correlate with EoE. For instance, these studies can identify structural changes in the esophagus such as strictures, narrowing, or dilations. In some situations, a CT scan of the chest may be employed for further assessment when complications or adjacent anatomical anomalies are suspected.
Employing fluoroscopy during a barium swallow test allows real-time observation of esophageal function and functionally can reveal dysmotility, providing clues to the disorder's impact on the patient’s swallowing mechanism. However, it must be stressed that while imaging brings observational insights, it does not substitute for tissue sampling since it cannot definitively diagnose EoE.
Laboratory Testing for EoE
Laboratory tests also contribute to the diagnostic framework for eosinophilic esophagitis. While no specific blood test directly diagnoses EoE, certain laboratory evaluations can assist in ruling out alternative explanations for the observed symptoms. Total IgE levels and specific allergen tests can help uncover allergic disease that might be driving the eosinophilic inflammation. Elevated IgE could indicate atopy which is often associated with EoE.
Furthermore, conducting patch tests or skin prick tests, when appropriate, can identify allergic sensitivities that might not be obvious from clinical history alone. These tests foster a better understanding of the patient’s allergy profile.
- Laboratory assessments streamline the diagnostic pathway, promoting effective management by correlating clinical symptoms with possible allergenic triggers.
In summary, while the imaging and laboratory testing cannot provide a definitive diagnosis of eosinophilic esophagitis on their own, they are integral to the overall diagnostic process. By merging clinical findings with imaging and laboratory results, healthcare providers can develop a substantial clinical picture, guiding appropriate management and therapeutic decision-making for patients with EoE.
Challenges in EoE Diagnosis
Diagnosing eosinophilic esophagitis (EoE) presents a multitude of challenges that can complicate patient management and lead to delays in appropriate treatment. Understanding these obstacles is essential for both clinicians and researchers. The variability in symptoms, the potential for misdiagnosis, and the overlap of EoE with other conditions render the diagnostic process complex. Addressing these challenges not only facilitates improved diagnostic accuracy but also enhances patient outcomes.
Variability in Symptoms
EoE is characterized by a spectrum of symptoms that can vary significantly from person to person. Some individuals may present with classic symptoms such as difficulty swallowing, also known as dysphagia, while others might experience more vague sensations such as chest pain or food impaction. This variability can lead to confusion during the initial clinical evaluation. Patients may report gastrointestinal discomfort, and symptoms can be exacerbated by dietary triggers, which can further complicate the diagnostic journey.
- Symptom Overlap: The range of symptoms associated with EoE can overlap with other esophageal and gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) or functional dyspepsia.
- Subjective Reporting: Patients often describe their symptoms subjectively, which makes it challenging to quantify the severity and impact of their condition.
Because of these factors, a comprehensive clinical assessment is vital. Careful documentation of symptoms and possible triggers is crucial to build a clearer picture for diagnosis.
Misdiagnosis and Overlap with Other Disorders
The potential for misdiagnosis is another significant challenge in EoE. Because the symptoms can mimic those of other gastrointestinal illnesses, clinicians may initially attribute them to different conditions. Misdiagnosis not only leads to inappropriate treatments but can also delay effective management strategies.
This overlap can occur with conditions like:
- Gastroesophageal reflux disease (GERD): Often, EoE is mistaken for GERD due to similarities in symptoms like heartburn and regurgitation.
- Achalasia: This is a disorder that affects esophageal motility and can create symptoms similar to EoE.
- Food allergies: Some patients may have underlying food allergies that warrant separate treatment considerations.
The diagnostic pitfalls demand high levels of clinical suspicion and knowledge. It is essential for healthcare providers to utilize comprehensive diagnostic tools, including endoscopic evaluations and histopathological examination, to differentiate EoE from these other conditions.
Investing time in understanding patients' complete medical history and symptom patterns can significantly enhance diagnostic accuracy.
In summary, the challenges in diagnosing EoE stem largely from the symptoms' variability and the potential for misdiagnosis. To improve patient care, it is essential to foster an awareness of these challenges among healthcare providers and advocate for more precise diagnostic strategies.
Management and Treatment Planning
Effective management and treatment planning for Eosinophilic Esophagitis (EoE) is essential. This condition often requires a multi-faceted approach tailored to individual patient needs. The primary objectives are to alleviate symptoms, restore esophageal health, and prevent potential complications. While the diagnosis provides a foundation, understanding how to manage the condition is crucial for improving patients' quality of life.
A comprehensive management strategy incorporates both dietary and pharmacological interventions. Each patient may respond differently to these strategies. Therefore, a personalized approach can offer the best outcomes. Education and collaboration among healthcare providers, patients, and their families can facilitate this process. Monitoring patient progress allows for adjustments in treatment plans as necessary.
Dietary Management Strategies
Dietary management is a cornerstone of EoE treatment. The goal is to eliminate food triggers that cause eosinophil activation. Specific dietary approaches include:
- Elemental Diet: This involves using hypoallergenic formula as the sole source of nutrition. This diet can help identify food triggers while also reducing inflammation.
- Elimination Diet: This diet method removes common allergens such as dairy, wheat, soy, eggs, and nuts. Slowly reintroducing these foods helps pinpoint specific allergens.
- Food Allergy Testing: Though less definitive, testing can guide dietary restrictions based on identified sensitivities.
Patients should work closely with a dietitian. A specialized dietitian can assist in planning meals that are not only nutritious but also tailored to avoid allergens. This proactive measure can significantly reduce symptoms and improve the overall management of EoE.
Pharmacological Interventions
Pharmacological approaches play a secondary yet vital role in managing EoE. Medications help to reduce inflammation and eosinophil levels in the esophagus. Common pharmacological interventions include:
- Topical Corticosteroids: Swallowed corticosteroids, such as fluticasone and budesonide, can help reduce inflammation effectively. They are usually the first-line treatment in symptomatic EoE.
- Proton Pump Inhibitors (PPIs): Though primarily used for acid suppression, PPIs can also be effective in some cases of EoE. Their role remains a subject of ongoing research, but they can provide symptomatic relief for certain patients.
- Biologics: Newer medications target specific pathways in the immune response. These treatments, while still being researched, show promise for patients who do not respond well to traditional therapies.
Collaboratively choosing between dietary interventions and pharmacological options ensures comprehensive care for the patient. Regular follow-ups allow for timely adjustments in management strategies.
Future Directions in EoE Research
The realm of Eosinophilic Esophagitis (EoE) research is rapidly evolving. As clinicians and scientists gain a deeper understanding of this chronic inflammatory disorder, several future directions are emerging. These advances can pave the way for innovative diagnostic and treatment strategies. The goal is to enhance patient outcomes and facilitate earlier diagnosis, which can drastically improve management of the condition.
Key areas of focus include the development of more accurate diagnostic techniques and the identification of potential biomarkers. These efforts may help to better distinguish EoE from similar diseases, establishing clearer paths for patient management. Moreover, genetic studies could provide insights that allow for tailored treatments, thus personalizing patient care.
Research in these areas can lead to significant benefits for both patients and practitioners. Accurate and rapid diagnosis can reduce the time it takes for patients to receive treatment. Further, it may minimize unnecessary invasive procedures, ultimately improving the quality of life for those affected by EoE.
Emerging Diagnostic Techniques
Emerging diagnostic techniques are essential to improving EoE identification. Traditional methods, such as endoscopy and biopsy, while effective, can be invasive. Therefore, there is a pressing need for less invasive alternatives.
Novel imaging technologies, for example, may provide insight without the need for extensive procedures. Techniques like high-resolution manometry and esophageal ultrasound are currently under exploration. Researchers are looking to refine these methods to detect eosinophilic inflammation accurately.
Additionally, non-invasive biomarkers in blood or saliva are an area of growing interest. Such biomarkers could streamline the diagnostic process, making it accessible in various healthcare settings.
Potential Biomarkers and Genetic Studies
The identification of potential biomarkers is an exciting avenue in EoE research. Biomarkers can provide valuable information about the disease and its mechanisms. They may indicate the presence of eosinophilic inflammation, providing a quicker diagnostic route than tissue biopsy.
Genetic studies are also gaining traction. Understanding genetic predispositions can help clarify who is at risk for developing EoE. This information brings possibilities of preventive strategies for high-risk groups. Some researchers are focusing on the specific genes associated with eosinophil regulation and inflammation. This understanding could lead to targeted therapy options that address the underlying mechanisms of EoE.
Epilogue
The conclusion of this article serves as a critical reflection on the complex nature of Eosinophilic Esophagitis (EoE) diagnosis. Understanding the nuances of diagnosis not only aids healthcare professionals in providing better patient care but also highlights the evolving knowledge around this condition. Key elements discussed in this article underscore the interplay between clinical features, diagnostic methodologies, and ongoing research.
The evolution of diagnostic criteria and the increasing recognition of EoE as a significant clinical entity point to a growing awareness and understanding of the condition. This is particularly important as accurate diagnosis contributes to effective management strategies that can significantly improve the quality of life for patients. The intricate relationship among various diagnostic techniques, challenges in evaluation, and the emerging insight into disease mechanisms forms the foundation of optimized patient care.
Overall, the insights gleaned from this exploration provide a robust framework for researchers, clinicians, and educators. They emphasize the importance of multidisciplinary approaches in navigating the complexities of EoE and encourage ongoing dialogue and investigation into better understanding its diagnosis and management.
Summary of Key Insights
- Eosinophilic Esophagitis is a chronic inflammatory disease marked by eosinophilic infiltration of the esophagus.
- Accurate diagnosis requires a combination of clinical assessment, endoscopic evaluations, and histopathological examinations.
- Understanding diagnostic criteria, including revised consensus guidelines, helps distinguish EoE from other similar disorders.
- Variability in symptoms presents challenges that can lead to misdiagnosis, necessitating thorough evaluation.
- Ongoing research into potential biomarkers and diagnostic methods is vital for advancing the understanding and treatment of EoE.
Importance of Early Diagnosis and Management
Early diagnosis of EoE is crucial for several reasons. Firstly, it allows for timely intervention aimed at mitigating symptoms and preventing complications. Patients may often experience significant discomfort and impairment in daily activities due to EoE, making early management crucial.
Moreover, early recognition of the condition helps to establish a more effective treatment plan tailored to the individual's specific needs. As there are various management strategies available, including dietary modifications and pharmacological therapies, understanding the disease promptly ensures appropriate measures can be taken.
Lastly, identifying EoE early can help in understanding its long-term implications. This condition, if left untreated, can lead to serious complications such as esophageal strictures and impaired esophageal function. Therefore, fostering awareness and prompt action can dramatically improve outcomes for those affected by Eosinophilic Esophagitis.
