Advances in diagnostic techniques for eosinophilic esophagitis: a systematic review of emerging noninvasive methods.

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by esophageal dysfunction and eosinophilic inflammation. Traditional diagnostic methods rely on endoscopy with biopsy, which is invasive and resource-intensive. The recent advancements have focused on developing noninvasive and minimally invasive diagnostic tools to improve patient experience and facilitate disease monitoring.

Objective: This systematic review aims to evaluate emerging noninvasive diagnostic techniques for EoE, including biomarkers, esophageal string tests (EST), and advanced imaging modalities, and their potential to complement or replace conventional diagnostic methods.

Methods: A systematic search was conducted in major databases, including PubMed, Embase, and Cochrane Library, to identify studies investigating noninvasive diagnostic approaches for EoE. Inclusion criteria focused on original research and clinical trials evaluating diagnostic accuracy, patient acceptability, and clinical utility. Data on diagnostic methods, outcomes, and limitations were extracted and analyzed.

Results: Emerging diagnostic methods, such as blood and urine biomarkers (e.g., EDN, ECP, eotaxin-3), EST, and advanced imaging (e.g., optical coherence tomography, EndoFLIP), demonstrated comparable sensitivity and specificity to endoscopic biopsy in detecting EoE. These tools offer advantages in reducing procedural burden, enabling dynamic disease monitoring, and enhancing patient adherence. However, challenges include variability in diagnostic thresholds and limited large-scale validation.

Conclusion: Noninvasive diagnostic tools for EoE hold promise in transforming clinical practice by reducing reliance on invasive endoscopy. Further research is needed to standardize protocols and validate these methods for routine use.