The twentieth eosinophil

Eosinophilic esophagitis has acquired the status of an independent adult condition only in the last few years, and criteria have been proposed to differentiate it from the eosinophilic infiltrates seen in a portion of patients with gastroesophageal reflux disease (GERD). Recent data, including the article summarized above, suggest that the interaction between GERD and eosinophilic esophagitis can be complex, and that the notion of establishing a clear distinction between the 2 disorders may be simplistic. Furthermore, the high frequency of GERD in adult patients with eosinophilic esophagitis suggests that there may be more than a chance association. This report discusses the possible relationship between these 2 conditions, including the hypothesis that GERD may contribute to or cause eosinophilic esophagitis. We also suggest that the differential diagnosis of eosinophilic and peptic esophagitis should not be based exclusively on arbitrary counts of eosinophils per high-power field; rather, there should always be a thoughtful consideration of histopathologic and clinical data.