Primary eosinophilic esophagitis (EE) is a rare disease with symptoms similar to those of gastroesophageal reflux disease (GERD). However, EE is caused by severe eosinophilic invasion of the esophageal epithelium, typically followed by dysphagia. A man 28 years of age presented persistent symptoms of GERD despite traditional antireflux therapy. Histologic evaluation showed eosinophilia (85 eosinophils/high-power field (x 400)). Treatment by bouginage resulted in mucosal lacerations and transitory clinical improvement. Local steroid therapy for four weeks eliminated the symptoms.