Considering the endoscopic and pathologic findings, the diagnosis would be eosinophilic esophagitis (EoE). EoE is an antigen-mediated disease of the esophagus in which chronic eosinophil-rich inflammation promotes symptoms and esophageal dysfunction [1]. EoE is distinguished by several endoscopic characteristics; hence, a high index of suspicion is warranted for endoscopic diagnosis. These characteristics include linear furrows (vertical lines), esophageal rings (concentric rings), edema (decreased vascularity), plaques (white spots, exudates), strictures, and a crepe paper-like esophagus (mucosal fragility) [2]. Hirano et al. proposed an endoscopic classification system for EoE in an attempt to standardize the method of endoscopic diagnosis (Table 1) [3]. Based on this classification, an endoscopic reference scoring system referred to as EREFS (an acronym consisting of exudates, rings, edema, furrows, and strictures) was created.

Endoscopic features play an important role in clinical suspicion, but the diagnosis should ultimately be based on biopsies and histopathology. A biopsy of the regions within the esophagus depicting abnormal findings should be performed. The European guidelines on EoE recommend biopsies of both the proximal and distal halves of the esophagus [4]. In addition, reference biopsies of the stomach and duodenum are necessary to exclude eosinophilic gastroenteritis, a secondary cause of eosinophilic infiltration in the esophagus. EoE is diagnosed when at least 15 eosinophils per HPF are detected. In this case, the biopsy of the esophagus showed significant intraepithelial eosinophilic infiltration of more than 15 eosinophils per HPF.