CHAPTER 11
Eosinophilic esophagitis

Yael Haberman Ziv¹, Margaret H. Collins¹, Nirmala Gonsalves², David A. Katzka³, and Marc E. Rothenberg¹

¹Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA

²Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

³Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen‐mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction, a distinctive spectrum of endoscopic findings, and histologically by eosinophil‐predominant inflammation. Figure 11.1 represents normal esophageal endoscopic finding of the proximal (Figure 11.1a) and distal (Figure 11.1b) esophagus without thickening, furrowing, exudate, erythema, or erosion. Esophageal endoscopic abnormalities in patients with EoE include whitish exudates (Figure 11.2a,b,e), edema (Figure 11.2), longitudinal furrows (Figure 11.2a,c,d), fixed esophageal rings/trachealization (Figure 11.2d), and narrow‐caliber esophagus or stricture (Figure 11.2e–g).

Typical histological findings of esophageal biopsy from a patient with EoE include a basal layer hyperplasia, numerous intraepithelial eosinophils (>15 eosinophils/high power field), dilated intercellular spaces, and thick and rope‐like connective tissue fibers in the lamina propria (Figure 11.3

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