Tests and diagnosisBy Mayo Clinic Staff
Your doctor will consider both your symptoms and test results to diagnose eosinophilic esophagitis. This will include determining whether you have:
- Gastroesophageal reflux disease (GERD), in which eosinophils usually are not present
- Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), in which eosinophils are present, but symptoms improve with proton pump inhibitor (PPI) medication
Tests to diagnose eosinophilic esophagitis include:
- Upper endoscopy. Your doctor will use a long narrow tube (endoscope) containing a light and tiny camera and insert it through your mouth down the esophagus. He or she will inspect the lining of your esophagus for inflammation and swelling, horizontal rings, vertical furrows, narrowing (strictures) and white spots. Some people with eosinophilic esophagitis will have an esophagus that looks normal.
- Biopsy. Your doctor will perform a biopsy of your esophagus, likely taking two to four samples of cells from two locations.
If doctors suspect eosinophilic esophagitis, you may be given some additional tests to confirm the diagnosis and to begin to look for the sources of your allergic reaction (allergens).
June 19, 2014
- Blood tests. You may be given a blood test to look for higher than normal eosinophil counts or total immunoglobulin E (IgE) levels, suggesting allergy.
- Medication trials. You may be given anti-reflux medication, specifically proton pump inhibitors (PPIs), to see if your symptoms improve. After 8 weeks, you will have a repeat endoscopy to see how healing has progressed.
- Dietary treatment trials. Your doctor may have you participate in a food elimination diet. This will include taking biopsies from your esophagus to learn how the disease responds to these dietary changes.
- Food-patch test. In this test, food is placed in a small container, which is then taped on your back, touching your skin. The doctor looks for inflammation on that spot.
- Bonus PAL, et al. Pathogenesis, clinical manifestations, and diagnosis of eosinophilic esophagitis. http://www.uptodate.com/home. Accessed Jan. 28, 2014.
- Dellon ES, et al. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). The American Journal of Gastroenterology. 2013;108:679.
- Feldman M., et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com.Accessed Jan. 18, 2014.
- Liacouras CA, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. Journal of Allergy and Clinical Immunology. 2011;128:3.
- Fell JME. Recognition, assessment and management of eosinophilic oesophagitis. Archives of Disease in Childhood. 2013;98:702.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. April 6, 2014.
- Gorospe EC, et al. New diagnostic and therapeutic frontiers in eosinophilic esophagitis. Minerva gastroenterologica e dietologica. 2013;59:59.
- Medical Edge from Mayo Clinic. Hard to Swallow — EOE. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. http://www.mayoclinic.org/medical-edge/. Accessed March 9, 2014.
- Molina-Infante J, et al. Review article: Proton pump inhibitor therapy for suspected eosinophilic oesophagitis. Alimentary Pharmacology & Therapeutics. 2013;37:1157.
- AskMayoExpert. Eosinophilic esophagitis (EE). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Eosinophilic esophagitis. American Academy of Asthma, Allergy and Immunology. http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis.aspx. Accessed Jan. 28, 2014.
- Alexander JA (expert opinion). Mayo Clinic, Rochester, Minn. March, 2014.
- Hirano I. Dilation in eosinophilic esophagitis: To do or not to do? Gastrointestinal Endoscopy. 2010;71:713.
- Lucendo AJ, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: A prospective study on the food cause of the disease. Journal of Allergy and Clinical Immunology. 2013;131:797.
- Katzka DA. The skinny on eosinophilic esophagitis. Gastroenterology. 2013;145:1186.
- Hurrell JM, et al. Prevalence of esophageal eosinophilia varies by climate zone in the United States. American Journal of Gastroenterology. 2012;107:698.
- Dellon ES. Diagnosis and management of eosinophilic esophagitis. Clinical Gastroenterology and Hepatology. 2012;10:1066.
- Safe use of complementary health products and practices. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/safety. Accessed Jan. 2, 2014.
- Rakel D. Integrative Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Jan. 2, 2014.
- Fass R. Alternative therapeutic approaches to chronic proton pump inhibitor. Clinical Gastroenterology and Hepatology. 2012;10:338.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. March 10, 2012.
- U.S. News best hospitals 2013-2014. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery. Accessed March 9, 2014.