Eosinophilic Esophagitis - Diagnosis

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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.

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See what others are saying

Comment from: FLL Mom, 55-64 Female (Patient) Published: April 21

I had episodes of food, particularly small pieces of poultry getting stuck in my esophagus. This happened rarely, and over the past 3 years I could always tough it out for the 2 to 5 minutes it took for food to pass. I assumed it was a Schatzki's ring or the like. What sent me to the gastroenterologist was an episode of a tiny piece of chicken getting stuck for more than 30 minutes. I almost went to the emergency room. An EGD and biopsy the next day revealed eosinophilic esophagitis with more than 40 eosinophils/HPF. I have been plagued with various allergies my entire life. I had a brief history of asthma in my late 30s and early 40s. I have severe pruritus and welts which pop up at different parts of my body on a daily basis. I live on Benadryl. I am going to see an allergist next week for consultation and testing.

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Comment from: VAltstatt, 13-18 Male (Caregiver) Published: April 25

My son (13 years old) just recently got diagnosed with eosinophilic esophagitis (EE). He has been having stomach pains for 7 months and was sent to a specialist at our state children"s hospitals for an EGD/with biopsy. The results came back for elevated eosinophils and thus the diagnosis of EE. He has been put on 2 acid reflux medicines for a trial run and then if they don"t work we will do food elimination to see if that"s the culprit. He has had eczema since 2 months of age and asthma his whole life. Multiple bouts of bronchitis his whole life as well. Hope that helps!

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