Eosinophilic Esophagitis (cont.)
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 to the stomach where the acid reflux is occurring. 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 rare cause of dysphagia is achalasia,
a disease of the nerves and the muscles of the esophagus that prevents the
muscle at the lower end of the stomach (the lower esophageal sphincter) from
relaxing and allowing swallowed food to pass into the stomach. Unlike the other
causes of dysphagia, achalasia usually results in problems swallowing both solid
and liquid food.
How is eosinophilic esophagitis diagnosed?
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 with 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, and 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. 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 the
channel of 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 has been 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.
Next: How is eosinophilic esophagitis treated? »
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- Endoscopy (Esophagogastroduodenoscopy, EGD) - Learn about the endoscopy procedure which examines the esophagus, stomach and duodenum to detect gastrointestinal and digestive disorders on MedicineNet.com
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