Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 12 January 2018, last major update October 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Eosinophilic esophagitis[TI] pathology free full text[sb]

Cite this page: Weisenberg, E. Eosinophilic esophagitis. website. Accessed October 22nd, 2018.
Definition / general
  • May be isolated, part of spectrum of eosinophilic gastroenteritis or associated with peripheral eosinophilia or reflux esophagitis
  • Patients may have enhanced production of cytokines against both food and environmental allergens (Dig Dis Sci 2006;51:1934)
  • More common in children; increasingly recognized
  • Generally believed to be increasing in incidence like other atopic disorders; but see Arch Pathol Lab Med 2007;131:777
Clinical features
  • Endoscopy: white flecks or plaques, stipple-like exudates, linear fissures or furrows, trachealization (ringed esophagus), strictures (Gastrointest Endosc 2004;59:835)
  • Symptoms include dysphagia (63%), vomiting and pain, progressing to odynophagia, stenosis and food impaction which may be presenting symptom; children may fail to thrive (World J Gastroenterol 2006;12:2328); onset in second or third decade is suggestive; also part of the rare anticonvulsant hypersensitivity syndrome (Dig Liver Dis 2008;40:145)
  • Diagnosis based on esophageal pH probes (not acidic), failure to respond to antireflux therapy, allergic history and biopsy
Case reports
Microscopic (histologic) description
  • Prominent intraepithelial eosinophils (15 or more in 2 or more high power fields or 20 - 25 or more in any HPF), microabscesses (42%), often with large clusters near surface
  • Also increased intraepithelial CD8+ T cells, intercellular edema, lamina propria fibrosis
  • Peripapillary eosinophils may represent an early stage
  • Endoscopic studies often include biopsies from both mid and distal esophagus
  • In general, unlike reflux disease, not more severe near GEJ
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Dr. Mark R. Wick:

Images hosted on other servers:

GERD features plus extensive eosinophils

Large number of intraepithelial eosinophils

Reflux esophagitis and eosinophilic esophagitis

Positive stains
Molecular / cytogenetics description
Molecular / cytogenetics images

Images hosted on other servers:

Eotaxin-3 mRNA expression

Differential diagnosis