Editing Eosinophilic oesophagitis (section)

== Diagnosis ==

* Eosinophils present on biopsy     (essential)
** Total of at least 6      biopsies: 2-4 biopsies each from the distal oesophagus and another 2-4      from the mid or proximal oesophagus, along with gastric and duodenal      biopsies looking for other diseases
** The vast majority of      patients have at least 15 eosinophils per hpf in at least one biopsy      specimen
** Also look for eosinophil      microabscesses, superficial layering of eosinophils, sheets of      eosinophils, extracellular eosinophil granules, subepithelial and lamina      propria fibrosis and inflammation, basal cell hyperplasia, papillary      lengthening, and increased numbers of mast cells/B cells/IgE-bearing      cells
* Accompanied by characteristic     symptoms (essential)
* Endoscopic appearance (not     essential)
** Feline oesophagus (stacked      circular rings) (44%)
** Strictures, especially      proximal (21%)
** Attenuation of the      subepithelial vascular pattern (41%)
** Linear furrows (48%)
** Whitish specks representing      eosinophil micro-abscesses (27%)
** Small calibre oesophagus      (9%)
* Other causes of oesophageal     eosinophilia have been excluded (essential)
** GORD
*** Favour EoE if proximal       oesophageal involvement, subepithelial lamina propria fibrosis,       eosinophilic abscesses, more severe basal cell hyperplasia, activated       mast cells
*** If histological findings       resolve with PPI alone, probably more GORD rather than EoE
*** EoE shouldn't be responsive       to PPI
** Recurrent vomiting from      other causes
** Parasitic and fungal      infections
** Allergic vasculitis
** Drug injury
** Connective tissue diseases
** Bullous pemphigoid
** Pemphigoid vegetans
** Graft-versus-host disease
** Achalasia
** Drug hypersensitivity
** Coeliac
** Vasculitis
** Carcinoma