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.

Return to Eosinophilic Esophagitis

See what others are saying

Comment from: niko, 35-44 Male (Patient) Published: March 11

I had some minor difficulty swallowing for a number of years. Heartburn, reflux after drinking or coffee/ chocolate, tomatoes and acidic juices were also present. I suffered from hay fever and asthma when young though I grew out of it. I recently had trouble breathing and after an endoscopy, was told likely to be eosinophilic esophagitis. Waiting on path. I am probably going to be given an asthma like puffer, I will know in a few weeks.

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Comment from: RCV, 25-34 Male (Patient) Published: April 14

Serious heartburn, trouble swallowing (I mean food being caught in my throat unable to pass until it was broken down), and excessive burping were the 3 factors that led to me going to the doctor. It also helps that my significant other (SO) is a nurse and was very concerned as to what she was witnessing. An endoscopy was done and they confirmed I have eosinophilic esophagitis (EE) and I"m now taking a 20 mg proton pump inhibitor twice a day which has greatly improved my quality of life.

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