Topic Completed: 1 October 2012

Revised: 5 September 2019

Copyright: 2003-2019,, Inc.

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

Elliot Weisenberg, M.D.
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Page views in 2019 to date: 8,654
Cite this page: Weisenberg E. Eosinophilic esophagitis. website. Accessed September 22nd, 2019.
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 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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