Tests and diagnosis

By 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).

  • 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.
June 19, 2014