[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Eosinophilic oesophagitis, and how it differs from reflux

# 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.

Updated Nov 12, 2026

## Key points

- Many intraepithelial eosinophils (a commonly used threshold is more than fifteen per high-power field), along the whole oesophagus.
- Endoscopy: stacked circular rings (feline or ringed oesophagus), linear furrows, white exudates and strictures.
- Adults: food impaction and dysphagia; children: feeding intolerance, vomiting, reflux-like symptoms.
- Atopy is common; cow milk is a frequent trigger; elimination diets can help.
- Responds poorly to acid suppression alone, unlike reflux.

## 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.

## Memory aid

Rings like a cat's tail, eosinophils from top to bottom, and a steak that will not go down.

## 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.

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## Elsewhere in DurgiPedia

- [Eosinophil](https://durgical.com/en/immunology/eosinophil/)
- [Type I hypersensitivity (immediate, IgE)](https://durgical.com/en/immunology/type-i-hypersensitivity/)
- [IL-4, IL-5 and IL-13 (the Th2 cytokines)](https://durgical.com/en/immunology/il-4-il-5-and-il-13/)

## Connections

## Related 3

- [Reflux oesophagitis: what acid does to the squamous lining](https://durgical.com/en/general-pathology/reflux-oesophagitis-what-acid-does-to-the-squamous-lining/)
- [Oesophageal obstruction: stenosis, webs, rings, diverticula](https://durgical.com/en/general-pathology/oesophageal-obstruction-stenosis-webs-rings-diverticula/)
- [Uncommon gastritis: eosinophilic, lymphocytic and granulomatous](https://durgical.com/en/general-pathology/uncommon-gastritis-eosinophilic-lymphocytic-and-granulomatous/)

## Related conditions 3

- [Eosinophilic oesophagitis](https://durgical.com/en/conditions/eosinophilic-oesophagitis/)
- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Asthma](https://durgical.com/en/conditions/asthma/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://medlineplus.gov/eosinophilicesophagitis.html) (MedlinePlus, US National Library of Medicine, 2025); [Esophagitis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001153.htm) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/eosinophilic-oesophagitis-and-how-it-differs-from-reflux/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/eosinophilic-oesophagitis-and-how-it-differs-from-reflux/