What prompts you to obtain esophageal biopsies in patients with GERD who have a normal-appearing esophagus on EGD and no dysphagia?

This is a good question. I do not routinely, unless there are other factors that steer me in the direction of eosinophilic esophagitis (EoE), such as a young patient with extraesophageal atopic disorders, where heartburn may be the presenting symptom of EoE.

If there is any question at all regarding the possibility of EoE (such as a young patient or a patient with allergies or atopic conditions), then I would biopsy. Also, remember that very young patients who have EoE may not present with the more typical dysphagia that adults do, and that these younge...