**5. Clinical feature**

Patients with eosinophilic esophagitis generally present with solid food dysphagia or esophageal food impaction requiring endoscopic removal of food bolus as an emergency case [16]. In one study, EoE was found in 9% of all cases of esophageal food impaction [17]. Commonly, the diagnosis is suspected after a first episode of esophageal food impaction and biopsy showing esophageal eosinophilia. Less commonly, patients present with heartburn and chest pain mimicking gastroesophageal reflux disease. One study found that gender was an important factor in the initial clinical presentation of eosinophilic esophagitis. Men presented with dysphagia and esophageal food impaction more commonly than women. Women presented with heartburn and chest pain more commonly than men [18]. Diffuse narrowing of the esophageal lumen has been seen in clinical practice as a result of chronic inflammation and fibrosis. Esophageal mucosa is friable in EoE, and as a result, esophageal mucosal tear and esophageal perforation can occur during endoscopic esophageal foreign body removal and during esophageal stricture dilation [19]. As aeroallergens play an important role in the pathogenesis, EoE is diagnosed more frequently when the environmental pollen counts (grass, trees and weeds) are high; the highest percentage of EoE occurs in the Spring and the lowest percentage in the Winter [20]. The diagnosis of EoE is not increased in the summer months [21].
