Eosinophilic Esophagitis (cont.)
Bhupinder Anand, MD
In this Article
What are the other causes of dysphagia for solid food?
The most common causes of dysphagia for solid food are esophageal strictures and Schatzki (lower esophageal) rings. Esophageal strictures are narrowings of the esophagus that result from inflammation and scarring, most commonly from chronic acid reflux. Strictures usually are located in the lower esophagus near the entrance of the esophagus into the stomach where the acid reflux is most severe. Schatzki rings are thin webs of tissue of unclear cause that can narrow the lumen (center) of the esophagus through which food passes. They also are located in the lower esophagus. A less common cause of dysphagia for solid food is esophageal cancer that narrows the esophageal lumen. A still less common cause of dysphagia is disorders of the muscles of the esophagus. For example, achalasia, a disease of the nerves and the muscles of the esophagus that prevents the muscle at the lower end of the esophagus (the lower esophageal sphincter) from relaxing and allowing swallowed food to pass into the stomach. Unlike the other causes of motility disorders, achalasia usually results in problems with swallowing both solid and liquid food.
How is eosinophilic esophagitis diagnosed?
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The diagnosis of eosinophilic esophagitis is suspected whenever dysphagia for solid food occurs, even though it is not one of the most common causes of dysphagia. Dysphagia almost always is evaluated by endoscopy (esophagogastroduodenoscopy or EGD) in order to determine its cause. During the EGD, a flexible viewing tube or endoscope is inserted through the mouth and into the esophagus. It allows the doctor to see the inner lining of the esophagus (as well as the stomach and duodenum). Cancers, esophageal strictures, Schatzki rings, and usually achalasia, all can be diagnosed visually at the time of EGD.
The doctor performing the EGD also may see abnormalities that suggest eosinophilic esophagitis. For example, some patients with eosinophilic esophagitis have narrowing of most of the esophagus. Others have a series of rings along the entire length of the esophagus. Still others have furrows running up and down the esophagus and a few have small white spots on the esophageal lining which represent pus made up of dying mounds of eosinophils. The diagnosis of eosinophilic esophagitis is established with a biopsy of the inner lining of the esophagus. The biopsy is performed by inserting a long thin biopsy forceps through a channel in the endoscope that pinches off a small sample of tissue from the inner lining of the esophagus. A pathologist then can examine the biopsied tissue under the microscope to look for eosinophils.
In many patients with eosinophilic esophagitis, however, the esophagus looks normal or will show only minor abnormalities. Unless biopsies are taken of a normal-appearing esophagus, the diagnosis of eosinophilic esophagitis can be missed. In fact, not taking biopsies has resulted in some patients having dysphagia for years before the diagnosis of eosinophilic esophagitis is made, and doctors are now more likely to perform biopsies of the esophagus in individuals with dysphagia--even those with a normal-appearing esophagus--who have no clear cause for their dysphagia.
The incidence of eosinophilic esophagitis is on the rise in the U. S. This rise in incidence may reflect either increased awareness of the disease among the doctors treating patients with dysphagia or an actual increase in the prevalence of this disease.
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