Eosinophilic Esophagitis: An Overlooked Entity in Chronic Dysphagia

Brian M. Yan and Eldon A. Shaffer


Nat Clin Pract Gastroenterol Hepatol. 2006;3(5):285-289. 

In This Article

Differential Diagnosis

The major differential diagnoses of eosinophilic esophagitis are GERD and peptic strictures. Table 1 describes the differences between GERD and eosinophilic esophagitis. The clinical history, endoscopic features, and histopathology help to distinguish between the two disorders. Acid regurgitation can lead to distal peptic strictures of the esophagus, with a low eosinophilic infiltration on biopsy (<10 eosinophils/HPF). Eosinophilic esophagitis can produce thick rings or extensive narrowing, usually in the more proximal esophagus, with marked eosinophilic infiltration (>20 eosinophils/HPF). The presence of typical GERD symptoms, including heartburn, acid reflux, and regurgitation, is not essential to diagnose eosinophilic esophagitis. Patients with GERD commonly show acid reflux on 24 h esophageal pH monitoring, whereas those with eosinophilic esophagitis are less likely to show signs of acid reflux. Furthermore, patients with GERD do not exhibit peripheral eosinophilia, which might be present in those with eosinophilic esophagitis. The management of GERD with acid-suppressive therapy is markedly different from the anti-inflammatory treatment necessary for eosinophilic esophagitis. Caution is advised in attempting to dilate 'peptic' strictures in patients with eosinophilic esophagitis as large mucosal tears might result, given the very friable mucosa. Conversely, esophageal perforations are not common in these patients, probably owing to the underlying fibrosis from the inflammatory response. The differential diagnoses of eosinophilic esophagitis are listed in Table 2 .


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: