GERD vs Eosinophilic esophagitis
How to tell GERD and Eosinophilic esophagitis apart when a board question makes them look alike.
GERD: heartburn that responds to PPI; eosinophilic esophagitis: dysphagia and food impaction with over 15 eosinophils per HPF despite PPI.
Side by side
Chronic heartburn and regurgitation, worse after meals or lying down, often responsive to acid suppression.
Dysphagia or food impaction in an atopic patient with esophageal rings and eosinophil-rich inflammation.
Incompetent lower esophageal barrier allows acidic gastric contents to reflux into the esophagus.
Allergic immune inflammation recruits eosinophils and remodels the esophagus into rings/strictures.
Typical reflux symptoms, erosive esophagitis, or pH monitoring supports GERD.
Concentric rings, linear furrows, food impaction, atopy, and eosinophils on biopsy support EoE.
The trap
Both can cause esophageal eosinophils or discomfort, so atopy and food impaction are key EoE clues.
The repair move
For esophageal symptoms, separate reflux/regurgitation from atopic dysphagia and impaction.
Try a free question
CoreA patient has chronic heartburn and regurgitation after meals that worsens when lying down and improves with acid suppression. Which diagnosis is most likely?
Show answer and explanation
Answer: A. GERD. GERD is reflux of gastric contents causing heartburn and regurgitation, often positional and meal-related.
Why the other choices are tempting
- B. Eosinophilic esophagitis often causes dysphagia or food impaction with allergic history.
- C. Achalasia causes dysphagia to solids and liquids with bird-beak narrowing.
- D. Squamous carcinoma causes progressive dysphagia and weight loss.
- E. Zenker diverticulum causes regurgitation of undigested food and halitosis.
Flashcards
Tap a card to flip it.
What symptom pattern favors GERD?
Heartburn and regurgitation after meals or when supine favors acid reflux.
What symptom pattern favors eosinophilic esophagitis?
Dysphagia with recurrent food impaction in an atopic patient favors EoE.
Quick answers
What is the fastest way to tell GERD from Eosinophilic esophagitis?
GERD: heartburn that responds to PPI; eosinophilic esophagitis: dysphagia and food impaction with over 15 eosinophils per HPF despite PPI.
What is the key clue for GERD?
Chronic heartburn and regurgitation, worse after meals or lying down, often responsive to acid suppression.
What is the key clue for Eosinophilic esophagitis?
Dysphagia or food impaction in an atopic patient with esophageal rings and eosinophil-rich inflammation.
What is the common trap with GERD vs Eosinophilic esophagitis?
Both can cause esophageal eosinophils or discomfort, so atopy and food impaction are key EoE clues.