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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
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.