Your doctor or specialist will likely make a diagnosis based on your answer to questions, a physical exam, and one or more tests. These tests may include:
For this test, you drink a solution containing a compound called barium or take a pill coated with barium. Barium coats the lining of the esophagus and stomach, and it enables the organs to be well outlined in a series of X-ray images. These images can help identify narrowing of the esophagus, other structural changes, a hiatal hernia, tumors or other abnormalities that could be causing symptoms.
A long, thin tube equipped with a tiny camera (endoscope) is guided down your throat and into the esophagus. Using this instrument, your doctor can view irregularities in the tissues of the esophagus and remove small tissue samples for testing. The appearance of the esophagus may also provide clues to the cause of inflammation. For example, the condition of the esophagus may look different depending on whether you have drug-induced or reflux esophagitis. You'll be lightly sedated during this test.
Small tissue samples removed during an endoscopic exam are sent to the lab for testing. Depending on the suspected cause of the disorder, tests may be used to:
- Diagnose a bacterial, viral, fungal or parasitic infection
- Determine the concentration of allergy-related white blood cells (eosinophils)
- Identify abnormal cells that would indicate esophageal cancer or precancerous changes
You may undergo tests to determine if you're allergic to a food or another allergy-causing agent (allergen) that may be causing eosinophilic esophagitis. These tests may include one of the following:
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- Elimination diet. Your doctor may recommend a diet with certain foods removed, particularly those foods that are common allergens. Under your doctor's direction, you'll gradually add foods back into your diet and note when symptoms return.
- Skin test. In this test, tiny drops of allergen extracts are pricked onto your skin's surface. This is usually carried out on the forearm, but it may be done on the upper back. The drops are left on your skin for 15 minutes before your skin is observed for signs of allergic reactions. If you're allergic to wheat, for example, you'll develop a red, itchy bump where the wheat protein extract was pricked onto your skin. Common side effects of these skin tests are temporary itching and redness.
- Franciosi JP. Eosinophilic esophagitis. Immunology and Allergy Clinics of North America. 2009;29:19.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm. Accessed Aug. 1, 2011.
- Castell DO. Medication-induced esophagitis. http://www.uptodate.com/home/index.html. Accessed Aug. 1, 2011.
- Graman PS. Esophagitis. In: Mandell GL, et al. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2010. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-443-06839-3..00094-1&isbn=978-0-443-06839-3&uniqId=270386537-4#4-u1.0-B978-0-443-06839-3..00094-1. Accessed Aug. 1, 2011.
- Patti MG. Gastroesophageal reflux disease: From pathophysiology to treatment. World Journal of Gastroenterology. 2010;16:3745.
- Geagea A, et al. Scope of drug-induced, infectious and allergic esophageal injury. Current Opinion in Gastroenterology. 2008;24:496.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 11, 2011.