Topic Completed: 1 October 2012

Revised: 30 March 2020

Copyright: 2003-2019,, Inc.

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

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Eosinophilic esophagitis. website. Accessed April 1st, 2020.
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)
  • Proton pump inhibitor responsive esophageal eosinophilia is considered by some an inappropriate disease descriptor because clinical features do not differ between those who are and are not response to PPIs (Curr Opin Gastroenterol 2017;33:285)
  • 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 contributed by Dr. Mark R. Wick

Various images

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
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