The Intricacies of the Histopathology of Eosinophilic Esophagitis: A Critical Review.

Eosinophilic esophagitis is a chronic, immune-mediated disorder that afflicts both adults and children. Dysphagia and food impaction are common symptoms in adults, whereas children experience failure to thrive, vomiting, and food aversion. On endoscopy, mucosal exudates, plaques, and furrows correlate with histologic inflammation, whereas rings and strictures are possibly related to a remodeled hyperplastic muscularis mucosae. The overreliance on intramucosal eosinophil counts for diagnosis and for the evaluation of response to therapy is a misguided oversimplification. A judicious analysis of the entire histopathologic picture offers a window that facilitates the understanding of the complexities of this disorder.