Eosinophilic and Infectious Esophagitis
Eosinophilic esophagitis from diagnosis (15 eosinophils per HPF) through EREFS scoring, the PPI / topical steroid / dietary algorithm, and dupilumab for refractory disease. Then the infectious differential, Candida, CMV at the ulcer base, HSV at the edge, and pill esophagitis, sorted by host immune status.
- Audio chapterAttending-narrated, listen on the commute.
- ABIM-format MCQs5-option vignettes with full wrong-answer teaching.
- Study guideTables, decision trees, primary sources.
- AI tutorChapter-grounded, answers the question you're stuck on.
What this chapter covers
- Section 5.1: EoE pathogenesis, diagnosis, and EREFS
Eosinophilic esophagitis is a Th2 allergic disease of the esophageal mucosa that begins with food allergen exposure in a genetically susceptible host and ends with fibrosis, rings, and food impaction if it is left untreated.
- Section 5.2: EoE treatment ladder
The EoE treatment ladder rests on three drug classes and one dietary strategy, and the decision to start with one rather than another is driven by adherence, allergic phenotype, and patient preference rather than by superiority of one option over the others.
- Section 5.3: EoE refractory disease and biologics
Refractory EoE is disease that fails to achieve histologic or clinical remission after an adequate trial of first-line therapy, and the modern definition increasingly includes patients who achieve histologic remission but have persistent dysphagia from established fibrostenotic change.
- Section 5.4: Candida esophagitis
Candida esophagitis is overgrowth of Candida albicans (and less commonly other Candida species) on a esophageal mucosa whose local defenses have failed.
- Section 5.5: HSV and CMV esophagitis
HSV and CMV esophagitis are sorted in the candidate's mind by where the virus lives in the mucosa, because the cellular tropism dictates the endoscopic ulcer morphology, the biopsy site, the histologic fingerprint, and ultimately the treatment.
- Section 5.6: Pill esophagitis and caustic injury
Pill esophagitis and caustic injury are mucosal chemical injuries that share a single mechanistic principle: the depth and extent of injury are determined by the agent and by the contact time.
Podcast episodes
- 01
Eosinophilic Esophagitis: Diagnosis Through Refractory Disease
Eosinophilic esophagitis is a Th2 allergic disease defined by at least 15 eosinophils per high-power field on biopsy. This episode builds it from the cytokine mechanism through the EREFS score, the topical steroid and diet treatment ladder, and dilation for strictures. Board Pearls GI board review.
- 02
Injury Esophagitis
The esophageal mucosa injured by something that touched it: Candida as the most common infectious cause and the gateway to an immunocompromise workup, HSV with volcano-edge ulcers and epithelial inclusions, CMV with deep ulcers and stromal inclusions, plus pill and caustic injury. Host status and biopsy site sort them. Board Pearls GI board review.