Eosinophilic Esophagitis - Diagnosis

Diagnosis

The diagnosis of eosinophilic esophagitis is a clinicopathologic one, requiring mucosal biopsies of the esophagus obtained during esophagogastroduodenoscopy. Normal esophageal mucosa does not have any infiltrating eosinophils. In eosinophilic esophagitis, eosinophils inflitrate the epithelium. A minimum of 15 eosinophils per high power field are required to make the diagnosis. Typically, eosinophils can be found in superficial clusters near the surface of the epithelium. Degranulated forms of eosinophils are also often visualized. In addition to esophageal infiltration, an expansion of the basal layer is seen in response to the inflammatory damage to the epithelium.

At the time of endoscopy, ridges, furrows, or rings may be seen in the esophagus wall. Presence of white exudates in esophagus is also suggestive of the diagnosis. Sometimes, multiple rings may occur in the esophagus, leading to the term "corrugated esophagus" or "feline esophagus" due to the similarity in the rings of the cat esophagus. In the radiology literature, the term "ringed esophagus" has been used for the appearance of eosinophilic esophagitis on barium esophagrams to contrast with the appearance of transient transverse folds sometimes seen with esophageal reflux (termed "feline esophagus").

A characteristic set of genes termed the "EE transcriptome" is expressed and distinguishes patients with EE from unaffected individuals or from patients with other forms of esophagitis.