How Eosinophilic Esophagitis Is Diagnosed

Eosinophilic esophagitis is a chronic immune disorder that affects the esophagus. The esophagus is the muscular tube that connects the mouth to the stomach and brings food into the body. In eosinophilic esophagitis, a type of white blood cells called eosinophils build up on the lining of the esophagus. This leads to difficulty swallowing and chest pain. 

The diagnosis process for eosinophilic esophagitis usually includes an upper esophageal scope, esophageal biopsy, and allergy testing. This article will detail the diagnostic tools used to test for eosinophilic esophagitis, as well as what to expect when seeing your doctor. 

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Self-Checks/At-Home Testing

There is no way to test yourself for eosinophilic esophagitis at home. However, it may be helpful to be aware of the common signs and symptoms to look for. Common symptoms of eosinophilic esophagitis in adults include:

  • Difficulty swallowing (dysphagia)
  • Painful swallowing 
  • Feeling as though food is getting “stuck” in the throat
  • Vomiting or regurgitation of food
  • Chest pain or heartburn 
  • Difficulty eating hard or dense foods 

Common signs of eosinophilic esophagitis in children include:

  • Decreased appetite 
  • Unable to eat or drink
  • Abdominal pain
  • Fussiness or irritability
  • Failure to gain weight 
  • Reflux that does not improve with medication or treatment 
  • Difficulty sleeping 

Eosinophilic esophagitis can affect anyone, but you may be more likely to experience it if you have any of the following risk factors:

  • History of allergic diseases
  • Family history of eosinophilic esophagitis
  • Male 
  • White 

Physical Examination

If you have been experiencing symptoms of eosinophilic esophagitis, it’s time to see your doctor. Your primary doctor will start the appointment by taking a thorough medical history. Because eosinophilic esophagitis shares many of its symptoms with more common diseases like gastroesophageal reflux disease (GERD), a detailed history is an important part of the diagnostic process. 

Your doctor will ask several questions, including:

  • What are your symptoms?
  • When did they start?
  • Does anything make them worse?
  • Do you ever feel like food gets stuck in your throat?
  • Have you ever had to vomit in order to remove the “stuck” food?
  • Do you have a history of allergies?
  • Has anyone in your family ever been diagnosed with eosinophilic esophagitis?

If eosinophilic esophagitis is suspected, your primary doctor will likely refer you to a gastroenterologist or an allergist. 

Labs and Tests

The two tests needed to diagnose eosinophilic esophagitis are an upper endoscopy and a tissue biopsy. 

  • Upper endoscopy: A medical procedure in which a small, flexible tube is passed down the esophagus. The tube contains a light and a camera lens so that the physician can view the inner lining of the esophagus. 
  • Biopsy: During an upper endoscopy, the physician will take biopsies of the esophagus tissue. The tissue samples are about the size of the tip of a pen. The samples are then examined under a microscope to look for eosinophils and other signs of inflammation. 

Your doctor will look for the following characteristics of the esophagus during the endoscopy:

  • Linear furrows: Grooves running down the esophagus
  • Mucosal rings: Rings along the inside lining of the esophagus
  • White plaques: Collections of white plaque in the esophagus

It’s important to note that you may have eosinophilic esophagitis even if your esophagus looks normal during the scope. Only a biopsy with eosinophils present can diagnose eosinophilic esophagitis. If the pathologist counts 15 or more eosinophils per high-powered microscopic field, a diagnosis of eosinophilic esophagitis is likely. 

Eosinophilic Esophagitis and Allergic Conditions

The majority of individuals with eosinophilic esophagitis also have symptoms of one or more other allergic conditions. These conditions can include asthma, eczema, allergic rhinitis, or food allergies. This is why people with eosinophilic esophagitis are usually treated by both a gastroenterologist and an allergist

  • Environmental allergies: Environmental allergens like pollen, dust mites, mold, and animal dander can trigger or worsen symptoms of eosinophilic esophagitis. 
  • Food allergies: An allergic reaction to food is a common trigger of eosinophilic esophagitis. However, the allergy can be difficult to diagnose because the reaction is often delayed by hours or even days. This is very different from other allergic reactions such as hives or vomiting, which usually occur within minutes of being exposed to the food. The most common foods associated with allergies are eggs, dairy products, soy, and wheat. 

Other diagnostic tests include:

  • Pinprick testing: Pinprick testing can help determine if your eosinophilic esophagitis symptoms are being caused by an allergic reaction. During pinprick testing, your doctor will use a prick device to introduce tiny amounts of allergens into your skin. If your skin becomes red and inflamed within 15 minutes, then you are likely sensitive to that specific allergen. Your treatment plan may include eliminating any allergens found during pinprick testing. 
  • Allergen-specific immunoglobulin E test: Your allergist may recommend a serum-specific immune assay blood test known as an allergen-specific immunoglobulin E (IgE) test. This test measures the amount of different IgE antibodies in the blood. The blood usually contains small amounts of IgE, but the amount increases when the body overreacts to an allergen. An allergen-specific IgE test can determine which allergen your body is reacting to. 
  • Food patch testing: Food patch tests were believed to be helpful in evaluating eosinophilic esophagitis in the past but are no longer used. These tests involve exposing the skin to a specific food for 48 hours and then observing for a reaction. This test can provide a false positive and is not regularly used in the diagnostic process for eosinophilic esophagitis. 

Differential Diagnoses

Eosinophilic esophagitis is a relatively rare autoimmune disease. If you have experienced symptoms such as difficulty swallowing or heartburn, they may be caused by a more common disease such as gastroesophageal reflux disease. More common gastrointestinal diseases are usually ruled out before arriving at an eosinophilic esophagitis diagnosis. 

Eosinophils can also be found in the esophagus in other gastrointestinal disorders.

Common diseases to rule out before being diagnosed with eosinophilic esophagitis include: 

  • Gastroesophageal reflux disease (GERD): A chronic digestive disease that causes a reflux of the stomach’s contents back into the esophagus
  • Ulcerative colitis: An inflammatory bowel disease that causes inflammation and ulceration of the lining of the large intestine
  • Crohn’s disease: An inflammatory bowel disease that causes severe inflammation in any part of the gastrointestinal tract

In addition to difficulty swallowing, other common signs and symptoms of GERD include:

  • Food regurgitation
  • Sore throat 
  • Chest pain
  • Inflamed gum tissue
  • Cavities 
  • Chronic cough 

Summary

Eosinophilic esophagitis is a chronic immune disease that causes an overgrowth of eosinophils on the inner lining of the esophagus. Upper endoscopy with biopsy is needed to diagnose this condition. Because eosinophilic esophagitis is often associated with food allergies, allergy testing may be performed as well.

Common gastrointestinal diseases to rule out before diagnosing eosinophilic esophagitis include gastroesophageal reflux disease (GERD), ulcerative colitis, and Crohn's disease. 

A Word From Verywell

Eosinophilic esophagitis can be difficult to diagnose, and the process may take time. As you attend appointments and undergo various tests, be sure to take time for yourself. This is a stressful time, so using your favorite stress management techniques may help. Reach out to loved ones for support or schedule an appointment with a health psychologist to learn new coping skills. 

Frequently Asked Questions

  • Does an endoscopy hurt?

    Endoscopy should not be painful but you may experience some discomfort after it. Your medical team may offer you a sedative medication to help you relax, as well as a throat numbing spray so you do not feel the tube going down your esophagus. Possible side effects of endoscopy include a sore throat, abdominal cramping, and bloating. 

  • What are the symptoms of eosinophilic esophagitis?

    Common symptoms of eosinophilic esophagitis in adults are: 

    • Difficulty swallowing, known as dysphagia 
    • Painful swallowing 
    • Feeling as though food is getting “stuck” in the throat
    • Vomiting or regurgitation of food
    • Chest pain or heartburn 
    • Difficulty eating hard or dense foods 

    Common symptoms of eosinophilic esophagitis in children are: 

    • Decreased appetite 
    • Unable to eat or drink
    • Abdominal pain
    • Food regurgitation 
    • Nausea and vomiting
    • Fussiness or irritability
    • Failure to gain weight 
    • Reflux that does not improve with medication or treatment 
    • Difficulty sleeping 
  • How is eosinophilic esophagitis treated?

    Eosinophilic esophagitis is usually treated with elimination diets and prescription medications such as proton pump inhibitors (PPIs) and corticosteroids. If those treatment options are unsuccessful, your medical team may recommend esophageal dilation.

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8 Sources
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