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- Patient Comments: Eosinophilic Esophagitis - Experience
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- Eosinophilic esophagitis facts
- What is eosinophilic esophagitis?
- What causes eosinophilic esophagitis?
- What are the symptoms of eosinophilic esophagitis?
- How does eosinophilic esophagitis cause dysphagia?
- What are the other causes of dysphagia for solid food?
- How is eosinophilic esophagitis diagnosed?
- How is eosinophilic esophagitis treated?
- What about elimination diets for treating eosinophilic esophagitis?
- What is the future of eosinophilic esophagitis?
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 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. This 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.