The only way to diagnose and monitor EoE is with a surgical procedure called an endoscopy. During this procedure, the doctor takes a flexible tube that has a camera and light on the end. This is called an endoscope. (Scope for short.) The endoscope goes in through the mouth, down through the esophagus into the stomach, and then into the first part of the small intestine. The doctor is looking for obvious signs of inflammation like redness, linear furrows, concentric rings or generalized narrowing of the esophagus. There can be active disease even with a healthy looking esophagus, so small tissue samples (biopsies) are taken from the esophagus, stomach and small intestine. The biopsies are the most important part of the procedure because that is the only way to tell if there are eosinophils where they shouldn't be.
EoE is a chronic condition, which means that there is no cure. Treatment goals are generally a remission of symptoms and histology. This means that (1) you feel better and (2) biopsies taken during treatment show healthy tissue. Note: EoE is not a cancerous condition, despite use of words like "biopsy" and "remission."
There are basically two treatments for EoE: dietary elimination and steroid management. Some patients use a combination of the two. There are some drugs being tested to see if they could be useful for EoE.
Dietary elimination works for nearly all patients, though the process of finding which foods need to be eliminated can be very difficult. The majority of patients can induce remission by removing a handful of foods from their diet. In some cases, the only way to figure it out is to remove all food so the patient is getting all nutrition from a formula that is broken all the way down to amino acids. (That has been the case for my Little Overachievers.) Once a repeat scope confirms remission, then you can add back one food at a time and wait to see if symptoms reappear. Repeat endoscopies are necessary every so often to gather biopsies that will be the factor that ultimately determines whether the foods introduced since the last procedure can be considered safe.
Steroid management is an alternative for those who prefer not to attempt or continue dietary management due to the cost or difficulty maintaining the sometimes extreme dietary exclusions that are necessary to induce remission. For these patients, studies show that corticosteroids that are typically inhaled to treat asthma can be swallowed instead to treat EoE. Repeat endoscopy is necessary to confirm remission, but follow up scopes can typically be spaced further apart than would be the case for patients utilizing dietary management. Not all patients respond to steroid management. In those cases, a patient may be able to use the steroids in combination with less extreme dietary elimination than would be required if the steroids were not used. Some patients are unable to utilize swallowed corticosteroids due to negative side effects.
Please check out my favorite Allergy & Eos Resources for more information. Feel free to post any questions about EoE in the comments below!