How do you manage a patient with dysphagia whose EGD shows mild esophageal rings and furrows, but histology was negative for interepithelial eosinophils?

That is a great question. The question stem gives the impression that the endoscopic appearance is suggestive of eosinophilic esophagitis. A few things to consider: First, I would make sure that the procedure was done off any treatment, especially PPI therapy. Many patients come for endoscopy already on a trial of a PPI (such as prescribed by their PCP). You want to be able to perform endoscopy in the patient's "native state" and not be influenced by any treatments. PPIs work in ~ 40-50% of EoE patients. If the patient was on a PPI, then biopsies may then reflect treated EoE. In our practice, when needed, we take patients off their PPI to then be able to perform endoscopy without the medication on board. Second, I would also ensure that the...