gastrointestinal disorders
Eosinophilic Esophagitis
Diagnosis of Eosinophilic Esophagitis
Endoscopy with biopsy Sometimes a barium swallow (See also the American College of Gastroenterology’s2013 Evidenced Based Approach to the Diagnosis and Management of Esophageal Eosinophilia and Eosinophilic Esophagitis (EoE).) The typical patient with eosinophilic esophagitis has dysphagia for solids and a history of atopy. The diagnosis of eosinophilic esophagitis is also considered when reflux symptoms fail to respond to acid-suppression therapy. It should also be considered in adults who present with esophageal food impaction or in adults who have noncardiac chest pain. Diagnosis requires endoscopy with biopsy showing eosinophilic infiltration (≥ 15 eosinophils/high-powered field). Although visible abnormalities (eg, linear furrows, strictures, stacked circular rings, loss of vascular markings, white exudates) may be apparent on endoscopy, the appearance can be normal, so biopsies are essential. Because GERD can also cause eosinophilic infiltrates, patients who have mainly reflux symptoms should have biopsies; samples from the proximal and middle esophagus should be processed separately from samples from the distal esophagus. Image provided by Kristle Lynch, MD. Image provided by Kristle Lynch, MD. Image provided by Kristle Lynch, MD. A barium swallow may show stacked circular rings, longitudinal furrows, a narrow-caliber esophagus, or strictures. Impedance Planimetry is occasionally used in patients with symptoms, despite histologic remission, to ensure there are no subtle strictures. Diagnosis is often done to identify possible triggers but is of minimal benefit because eosinophilic esophagitis is not thought to be IgE-mediated. 