Abstract

Background: Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) are commonly regarded as distinct disorders. However, several clinical and histologic overlaps challenge this separation.
Aim: To analyze current inconsistencies in the understanding of GERD and EoE and to propose an alternative pathophysiological concept linking both conditions. Methods: A critical review of literature and radiographic observations was conducted to evaluate the relationship between esophageal inflammation, acid hypersecretion, and allergic response.
Results: Current consensus definitions of GERD rely on symptom-based or instrumental criteria rather than histological confirmation, which may lead to diagnostic underestimation. Evidence suggests that EoE represents a histological variant of reflux esophagitis in individuals with allergic predisposition. The initiating event is hypersecretion of hydrochloric acid. Acid, penetrating the esophagus, disrupts mucosal integrity and induces an inflammatory response. The allergic component promotes fibrotic thickening of the esophageal wall, leading to narrowing, dysphagia, and sometimes formation of a Schatzki ring.
Conclusion: EoE may be interpreted as reflux esophagitis modified by allergic inflammation. Recognizing the shared pathogenesis of GERD and EoE could improve diagnostic accuracy and treatment strategies. There is reason to believe that the Schatzki ring is a manifestation of EoE. High reliability of radiographic examination using radiometric analysis of radiographs has been demonstrated.

Keywords

Eosinophilic esophagitis, gastroesophageal reflux disease, hypersecretion of hydrochloric acid, allergic inflammation, Schatzki ring, rigid antral gastritis