Gastroesophageal Reflux Disease (GERD)
Differential Diagnosis
Gastroeophageal Reflux vs Eosinophilic Esophagitis
| Intraepithelial Eosinophils | Diagnosis |
| ≥15-20/HPF | Marked intraepithelial eosinophilia consistent with eosinophilic esophagitis if other causes are ruled out (see below) |
| 5-14/HPF | Indeterminate for eosinophilic esophagitis |
| <5/HPF | Consistent with reflux |
Eosinophilic GI disorders by location
| Eosinophilic Esophagitis | Eosinophilic Gastroenteritis | Eosinophilic Proctocolitis |
|---|---|---|
| Confined to esophagus | Involves stomach and/or small intestine | Confined to rectum and colon |
| Good response to dietary manipulation | Poor response to dietary manipulation | Good response to dietary manipulation |
Eosinophils may be numerous in other diseases
- Food impaction must be ruled out clinically
- Lodging of medicinal agents (pill esophagitis) must be ruled out clinically
- Drug related must be ruled out clinically
- Hypereosinophilic syndrome
- Requires >1500 eosinophils / microliter
- Parasitic disease must be ruled out by stool examination
- Crohn disease
- May contain many eosinophils in the infiltrate but they do not predominate
- Very rare in esophagus
- Milk protein enteropathy must be ruled out clinically especially in infants
- Systemic diseases
- Churg Strauss vasculitis
- Polyarteritis nodosa
- Scleroderma
- Stevens-Johnson syndrome
