How is reflux esophagitis differentiated from eosinophilic esophagitis (EoE)?

Updated: Jan 03, 2020
  • Author: Nina Tatevian, MD, PhD, FCAP; Chief Editor: Nirag C Jhala, MD, MBBS  more...
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Answer

Answer

This is histological manifestation of GERD that causes esophageal mucosal damage by passive backflow of gastric contents into the distal esophagus. There is considerable histological overlap between reflux esophagitis and EoE. Typically, histological features of reflux esophagitis include mild to moderate basal cell hyperplasia, elongation of vascular papillae, dilated intercellular spaces, increased intraepithelial lymphocytosis, and the presence of intraepithelial eosinophils that number less than 5-7/hpf.

However, in some cases, distal esophageal biopsy samples show a spectrum of overlapping features of reflux esophagitis and EoE. These include moderate to marked basal cell hyperplasia (>50% of mucosal thickness), papillary elongation to 75% of mucosal thickness, dilated intercellular spaces, and the presence of peak intraepithelial eosinophilic counts ranging from 7-14/hpf. In such cases, histological evaluation of additional biopsy samples from the proximal esophagus and midesophagus may be helpful in reaching a more definitive diagnosis. [48, 49]


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