Endoscopically, ridges, furrows, or rings in the oesophagus wall can be detected. Due to the likeness of the rings to the cat oesophagus, several rings may form in the oesophagus, giving rise to the terms "corrugated oesophagus" or "feline oesophagus." The presence of white exudates in the oesophagus further suggests the diagnosis. Many eosinophils can be detected in the superficial epithelium of a biopsy collected during an endoscopy.
The diagnosis requires at least 15 eosinophils per high-power field. Eosinophilic inflammation does not only affect the oesophagus but also the rest of the gastrointestinal tract. Profoundly degranulated eosinophils, as well as microabscesses and basal layer enlargement, may be observed. Individuals who have evidence of Eosinophilic Esophagitis (EoE) on endoscopy should have an 8-week trial of high-dose proton pump inhibitor medication (twice daily) before having another endoscopy to rule out GERD. Although endoscopic findings can help identify patients with EoE, they are not diagnostic if the patient does not have clinical symptoms.
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