Approach

Eosinophilic oesophagitis (EoO) symptoms and signs are non-specific, and diagnosis is based on clinicopathological features. Clinically, there must be symptoms of oesophageal dysfunction. Histologically, there must be an oesophageal epithelial infiltrate of ≥15 eosinophils per high-power microscopy field (eos/hpf).[1][2][3] 

Competing causes of oesophageal eosinophilia must be excluded prior to confirming the diagnosis; a finding of increased eosinophils alone on biopsy is not itself diagnostic. While there are unusual causes of oesophageal eosinophilia (such as oesophageal Crohn's disease, connective tissue or autoimmune disorders, hypereosinophilic syndrome, a more diffuse eosinophilic gastroenteritis, parasitic infections, drug reactions, pill oesophagitis, and graft versus host disease affecting the oesophagus) these can usually be excluded by the history, physical examination, and standard blood tests. From a practical standpoint, the most common condition to evaluate for as contributing to oesophageal eosinophilia is gastro-oesophageal reflux disease (GORD).[82]

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