Update on Esophagitis: Controversial and Underdiagnosed Causes

Abstract

Abstract Context.—Esophagitis is a common cause of symptoms for which patients seek the advice of a physician. Esophagitis of differing etiologies often demonstrate overlapping histopathologic features, making their distinction difficult. This is especially true in esophageal disorders associated with increased numbers of intraepithelial eosinophils, some of which have just recently been recognized. Objective.—This review discusses the important clinical and pathologic features of the 2 most common disorders associated with esophageal eosinophilic infiltrates—reflux esophagitis and eosinophilic esophagitis—with special emphasis on features that allow the surgical pathologist to distinguish between these disorders. The various forms of drug-induced esophagitis are also discussed because these are frequently underrecognized by pathologists. Data Sources.—Data were extracted from articles identified through PubMed-based research. Histologic figures have been taken from the personal case collection of the author. Conclusions.—Reflux and eosinophilic esophagitis demonstrate overlapping histologic features, which may make their distinction difficult. Drug-induced esophagitis is probably a common phenomenon but is underrecognized by pathologists.