Eosinophilic (Allergic) Esophagitis

Epidemiology and Etiology:

· Children or young adults

· Males > Females

· Accompanied by other allergic conditions usually

· May be accompanied by eosinophilic gastroenteritis

Common sites:

· Involves both proximal and distal esophagus characteristically

Gross features:

· Esophageal rings maybe

· Vertical furrows maybe

· White papules maybe

· Strictures maybe

· Plaques maybe

Histologic features:

· High intraepithelial eosinophil counts (>15-20 / HPF)

· Eosinophilic microabscesses or aggregates

· Propensity for superficial layers

· Intraepithelial mast cells (immuno may be required)

· Squamous hyperplasia (same as GERD)

Immunophenotype:

Marker:	Sensitivity:	Specificity:
IgE (intraepithelial cells)
Tryptase (intraepithelial cells)

Molecular features:

·

Other features:

· Progressive dysphagia for solids classically

· Normal or near normal acid pH probe study

· Poor response to anti-reflux therapy

· Peripheral blood eosinophilia often

· Responds to steroids often

References:

· Kirsch R, Bokhary R, Marcon MA, Cutz E. Activated mucosal mast cells differentiate eosinophilic (allergic) esophagitis from gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2007;44(1):20-6.

· Silverberg SG, DeLellis RA, Frable WJ, LiVolsi VA, Wick MR. Silverberg's Principles and Practice of Surgical Pathology and Cytopathology: 2-Volume Set. 4th ed. Churchill Livingstone; 2005.