What is a diagnostic biopsy characteristic for eosinophilic esophagitis (EoE)?

The correct response highlights a key diagnostic criterion for eosinophilic esophagitis (EoE). In considering the appropriate diagnosis of EoE, the presence of greater than 15 eosinophils per high powered field (HPF) is particularly important, especially in the context of evaluating patients who have undergone a trial of proton pump inhibitors (PPIs) for at least 8 weeks.

This context is crucial because it helps to differentiate EoE from other conditions, such as gastroesophageal reflux disease (GERD), which can also cause esophageal symptoms and may demonstrate eosinophilia. Importantly, if eosinophils are still present even after PPI treatment, it supports the diagnosis of EoE, highlighting that this condition persists regardless of acid suppression therapy.

In contrast, other listed options do not align with the established diagnostic criteria. Detecting fewer than 15 eosinophils would not confirm EoE, and the absence of eosinophils or the presence of neutrophils could suggest alternative diagnoses rather than EoE itself. Thus, the requirement of finding greater than 15 eosinophils per high powered field while on a PPI for 8 weeks provides a robust