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Eosinophilic esophagitis (EoE) is diagnosed by linking esophageal symptoms with the presence of eosinophils cells in esophageal mucosa. Dysphagia is encountered in more than 80 percent of the cases. Food impaction frequently reveals the disease. An upper gastro-intestinal endoscopy with at least six esophageal biopsies is mandatory for confirming the diagnosis. An endoscopy can show esophageal rings, strictures, longitudinal furrows, white exudates, or be normal. Biopsies are taken from at least two different sites in the esophagus in pathological and normal mucosa. The diagnosis is confirmed during histological examination if there are at least 15 eosinophils per high power field (60/mm²) in the esophageal mucosa. During the initial endoscopy, gastric and duodenal biopsies should be performed if symptoms are compatible with eosinophilic gastro-enteritis (vomiting, abdominal pain, diarrhea). A barium swallow is useful for assessing the esophageal caliber or for identifying the presence of a stricture that could be treated endoscopically.