Background and study aim: Eosinophilic esophagitis (EE) is defined as the presence of an abundant eosinophil infiltrate of the esophageal mucosa observed at biopsy. For some time, the existence of a patho-physiological relationship between GERD and EE has been speculated. The aim of this work is to estimate the frequency of eosinophilic esophagitis among patients with refractory reflux esophagitis Patients and methods:We selected fifty patients diagnosed previously as refractory GERD(group I) . Another fifty patients corresponding in age and sex with group I with esophageal and extra-esophageal clinical symptoms suggestive of GERD were enrolled in this study as control (group II). All patients were subjected to upper GIT endoscopy (multiple biopsies were taken), 24 hrs esophageal PH monitoring, esophageal motility study, histopathology and immune -histochemistry of esophageal biopsies. Results : Two patients with EE were found among patients with refractory GERD. Dysphagia, heart burn, and food impaction were the common presenting symptoms of patients with EE. Rings and furrow were the most common and significant endoscopic pictures in cases of EE. Eosinophils, microabces, basal zone hyperplasia and increased lamina propria papillae were the significant specific finding for EE in esophageal biopsies. Esophageal dysmotility and occurrence of reflux were common and significant in patients with EE. Immuno-histochemistry had high sensitivity in detection of eosinophils and its degradation product in esophageal biopsies. Conclusion : eosinophilic esophagitis is one of the causative factors of refractory GERD and its frequency is about 4%.It should be put in differential diagnosis of cases of refractory GERD. Endoscopic picture is suggestive but biopsy for EE is confirmatory