Eosinophilic oesophagitis, and how it differs from reflux
- Lesion
An allergy-type inflammation fills the oesophagus with eosinophils, stiffens it and makes food get stuck.
What it is
Eosinophilic oesophagitis is a chronic, immune-mediated disease driven by food antigens in people with an atopic tendency. Many patients also have asthma, allergic rhinitis or eczema. Th2 cytokines (interleukins 4, 5 and 13) and mast cells recruit large numbers of eosinophils into the squamous epithelium, and the chronic inflammation lays down subepithelial fibrosis that narrows the oesophagus.
Structure
- Marked intraepithelial eosinophilia, sometimes with eosinophil microabscesses at the surface.
- Basal zone hyperplasia and dilated intercellular spaces.
- Subepithelial (lamina propria) fibrosis in long-standing disease.
Eosinophilic oesophagitis vs reflux oesophagitis
| Feature | Eosinophilic oesophagitis | Reflux oesophagitis |
|---|---|---|
| Cause | Food-antigen–driven Th2 inflammation | Acid and pepsin reflux |
| Distribution | Proximal and distal oesophagus | Distal, near the junction |
| Eosinophils | Very many, often in clusters and near the surface | Few, scattered |
| Endoscopy | Rings, furrows, white specks, narrow calibre | Redness and erosions above the junction |
| Typical patient | Young atopic person with food impaction | Adult with heartburn |
Clinical notes
- A young adult with food stuck in the oesophagus should have biopsies from upper and lower oesophagus.
- Treatment options are diet elimination, acid suppression, topical glucocorticoids and dilation of strictures.
Test yourself
Think of the answer, then tap the question to see it.
Which cytokine pattern drives eosinophilic oesophagitis?
A Th2 pattern, with interleukins 4, 5 and 13, together with mast cells, in atopic people exposed to food antigens.
What does the oesophagus look like at endoscopy in eosinophilic oesophagitis?
Stacked circular rings (feline oesophagus), linear furrows, white exudates and sometimes strictures.
How does the distribution of eosinophils help separate it from reflux?
In eosinophilic oesophagitis they are numerous in the proximal as well as distal oesophagus; in reflux they are few and distal.
Elsewhere in DurgiPedia
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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Eosinophilic Esophagitis (MedlinePlus, US National Library of Medicine, 2025); Esophagitis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.