Eosinophilic esophagitis

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Author: Mikael Häggström [notes 1]

Microscopic diagnosis

Eosinophilic infiltrate. In this case also intercellular edema giving a spongy appearance.

It is characterized by a prominent eosinophilic infiltrate in the esophagus, with consensus guidelines defining it as over intra-epithelial 15 eosinophils per HPF.[1] [notes 2]


  • If positive:
  • Presence of eosinophilic esophagitis
  • Number of eosinophils per HPF

In borderline cases, such as an incidental finding of eosinophils at around 15/HPF, a separate explanatory comment can be made, such as:

(Esophagus, biopsy:)
Squamous mucosa with increased intraepithelial eosinophils of up to 15/HPF. See comment.

Comment: There is no evidence of eosinophilic microabscesses. Although this may represent reflux esophagitis, a diagnosis of eosinophilic esophagitis is considered in the correct clinical setting.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. It has also been described as ≥15 intraepithelial eosinophils in ≥2 hpfs or ≥25 in any single hpf.
    - Parfitt, Jeremy R; Gregor, James C; Suskin, Neville G; Jawa, Hani A; Driman, David K (2005). "Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients ". Modern Pathology 19 (1): 90–96. doi:10.1038/modpathol.3800498. ISSN 0893-3952. 

Main page


  1. Dellon, Evan S. (2012). "Eosinophilic esophagitis ". Current Opinion in Gastroenterology 28 (4): 382–388. doi:10.1097/MOG.0b013e328352b5ef. ISSN 0267-1379.