ReviewAnnals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology2026
Shifting the scope: Moving toward less invasive diagnosis and monitoring of eosinophilic esophagitis.
Review in Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLess invasive diagnostics that decrease dependence on sedated endoscopy are needed for eosinophilic esophagitis (EoE).
objectiveTo review the literature describing alternatives to conventional upper endoscopy in EoE. DATA SOURCES: A literature search was conducted using MEDLINE for articles published through March 2026. STUDY SELECTIONS: Articles were considered for inclusion if they evaluated clinically available minimally invasive diagnostic tools or noninvasive biomarkers under investigation for EoE. Both adult and pediatric studies were considered. Case reports/series were excluded.
methodsStudies were grouped into categories, including minimally invasive sampling devices and noninvasive biomarkers. Noninvasive biomarkers were further subdivided into biomarkers for screening, surveillance, and prognostication. Data were qualitatively synthesized given the heterogeneity in study design and outcomes.
resultsUnsedated transnasal endoscopy (TNE) and the esophageal string test (EST) are clinically available, minimally invasive surrogates for conventional sedated endoscopy. Completion rates are high for TNE (>95%) and the EST (>86%). Both are well tolerated and reduce overall visit time and cost. TNE and EST are best suited for disease monitoring in adolescents and adults after EoE is diagnosed. Eosinophil counts, eosinophil-derived proteins, and eosinophil activation markers are the most widely investigated noninvasive blood biomarkers. RNA and microRNA biomarkers and specific cell types (eg, pathogenic effector T
conclusionMinimally invasive diagnostics can be implemented to monitor EoE disease activity. Additional studies with allergic controls are needed to validate noninvasive EoE biomarkers for screening, surveillance, and predicting disease/treatment outcomes.
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