Proposed criteria to differentiate heterogeneous eosinophilic gastrointestinal disorders of the esophagus, including eosinophilic esophageal myositis

Figure 6 Proposed diagnostic criteria for eosinophilic gastrointestinal disorders in the esophagus. Patients with esophageal symptoms receive endoscopy. ¹Mucosal biopsy should include a sufficient amount of subepithelium together with epithelium to allow subepithelial eosinophilia to be identified. If no or low degree of eosinophilia is seen in the epithelium/subepithelium but manometry shows abnormal peristalsis and elevated serum immunoglobulin E (s-IgE) level, peroral esophageal muscle biopsy (POEM-b) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is recommended to detect eosinophilia in deeper layers. ²Manometry findings and s-IgE levels are variable, careful follow-up is recommended even if the findings are normal initially; Other alternative causes of esophageal symptoms should be ruled out.