Clinical Presentation of EoE in Adults: A Characteristic Story!?

BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic, progressive, immune-mediated disease characterized by symptoms of esophageal dysfunction and a dense eosinophilic infiltration of the esophageal mucosa (≥15 eosinophils/high-power field or ≥60 eosinophils/mm2). The diagnosis requires the exclusion of other local or systemic causes of esophageal eosinophilia. EoE is frequently associated with atopic disorders, including asthma, allergic rhinitis, and atopic dermatitis, reflecting its complex immunopathogenesis. SUMMARY: Adults with active EoE may present with a broad spectrum of symptoms, most commonly dysphagia and food impaction, the latter often requiring urgent endoscopic intervention. Endoscopy plays a central role in both the diagnosis and monitoring of EoE. Although endoscopic appearances may vary, characteristic findings include edema, esophageal rings, whitish exudates, linear furrows, and strictures. These features are systematically assessed using the Endoscopic Reference Score (EREFS), which provides a standardized measure of endoscopic disease activity and severity. Recognition of these clinical manifestations and endoscopic abnormalities is essential for accurate diagnosis, disease assessment, and therapeutic management. KEY MESSAGES: EoE is a chronic inflammatory esophageal disorder with distinct clinical and endoscopic manifestations. Dysphagia and food impaction are the hallmark symptoms in adults, while endoscopic evaluation remains indispensable for diagnosis and follow-up. The use of standardized scoring systems such as EREFS improves the assessment of disease activity and facilitates consistent monitoring. Early recognition of clinical symptoms and characteristic endoscopic findings is critical for optimizing patient care and preventing long-term complications.