Materiały źródłowe

• #1 Esophagitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK442012/

  Esophagitis refers to inflammation or injury to the esophageal mucosa. One of the most common causes is gastroesophageal reflux, which can lead to erosive esophagitis. Other etiologies include radiation, infections, local injury caused by medications, pill esophagitis, and eosinophilic esophagitis (EoE). The most common symptoms in patients with esophagitis are chest pain, odynophagia, and dysphagia. Patients with EoE may present with food impaction. If the esophagitis is severe and leads to strictures, fistulization, and perforation, patients may present with symptoms related to those entities. […] Diagnosis of esophagitis can be made based on history and clinical examination however to differentiate subtypes of esophagitis requires endoscopy and biopsy examination. In suspected acid reflux esophagitis if symptoms are mild to moderate then an endoscopy may not be required and can be reserved if poor or failed response to proton pump inhibitors. Similarly, if the history is very suggestive of medication-induced (pill) esophagitis, endoscopy may not be initially required.

• #1 Esophagitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10138-esophagitis

  Esophagitis is inflammation in your esophagus, the swallowing tube that runs through the middle of your chest. It might feel like chest pain, or it might make swallowing painful or difficult. […] A healthcare provider can often diagnose esophagitis based on your symptoms. They might give you a prescription for acid-blocking medications to see if it helps. If it does, they can assume reflux esophagitis. If it doesn’t, they might need to investigate further. They might look inside your esophagus with an upper endoscopy or measure the acid content in your esophagus with an esophageal pH test. […] Esophagitis will heal if you can stop what’s irritating your esophagus long enough to let the natural healing process continue. This may require various lifestyle changes or medications, depending on the cause. Medications can also help to protect and promote healing in your esophagus.

• #1 Esophagitis Differential Diagnoses

  https://emedicine.medscape.com/article/174223-differential

  Always consider the possibility of a systemic illness causing the esophageal manifestations (eg, acquired immunodeficiency syndrome [AIDS], scleroderma, systemic lupus erythematosus (SLE), pemphigus). Always consider cardiac causes of chest discomfort and treat appropriately. If the diagnosis is unclear, admission for further evaluation is suggested. Do not misdiagnose cardiac chest pain as esophageal pain. Pain can be similar, particularly in elderly patients and women. […] Glycogenic acanthosis, reflux esophagitis, herpes esophagitis, and superficial spreading carcinoma may produce findings similar to those seen in Candida esophagitis. However, patients with glycogenic acanthosis are almost always older individuals who have no esophageal symptoms, and the mucosal nodules of glycogenic acanthosis tend to have a more rounded appearance, whereas the plaques of candidiasis are more linear.

• #1 Eosinophilic esophagitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] Your health care provider will consider both your symptoms and test results to diagnose eosinophilic esophagitis. This will include determining whether you have gastroesophageal reflux disease (GERD). […] Tests to diagnose eosinophilic esophagitis include: […] Upper endoscopy. Your provider will use a long, narrow tube (endoscope) containing a light and tiny camera and insert it through your mouth down the esophagus. The lining of your esophagus will be inspected for inflammation and swelling, horizontal rings, vertical furrows, narrowing (strictures), and white spots. Some people with eosinophilic esophagitis will have an esophagus that looks typical.

• #1 Esophagitis: Causes, Symptoms, & Treatments

  https://www.webmd.com/digestive-disorders/esophagitis

  Esophagitis Diagnosis […] Once your doctor has done a physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include: […] Upper endoscopy […] A test in which a long, flexible lighted tube, called an endoscope, is used to view your esophagus. […] Esophageal sponge […] In this test, you swallow a capsule that has a string attached. In your stomach, the capsule dissolves, releasing a sponge. Your doctor pulls the sponge up by the string, and the sponge takes samples of your tissue as it comes out. The sample then is checked by a lab. This procedure lets you skip an endoscopy. […] Biopsy […] During this test, a small sample of the esophageal tissue is removed and then sent to a lab to be checked under a microscope. […] Upper GI series (or barium swallow) […] During this procedure, X-rays are taken of the esophagus after you drink a barium solution. Barium coats the lining of your esophagus and shows up white on an X-ray. This lets doctors see problems in your esophagus.

• #1 Role of endoscopy in eosinophilic esophagitis

  https://www.e-ce.org/journal/view.php?number=7903

  Biopsy samples should be taken from the distal and mid-/proximal esophagus for EoE diagnosis. […] The typical endoscopic findings of EoE are esophageal edema, rings, exudates, furrows, and stenosis. […] In patients suspected with EoE, biopsy samples should be obtained from the esophagus regardless of endoscopic appearance. […] Follow-up endoscopies with biopsy are usually recommended to assess response because symptoms may not always correlate with histologic findings. […] Endoscopic dilation or bougienage can be used in combination with medical and/or dietary treatment in patients with esophageal stricture for the management of dysphagia and to prevent its recurrence.

• #1 Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances

  https://www.mdpi.com/2075-4418/12/12/3202

  Several efforts to improve recognition and diagnostic accuracy of endoscopic abnormalities using image enhancement endoscopy (IEE), endocytoscopy, and artificial intelligence (AI) have been recently reported. […] The EoE endoscopic reference score (EREFS) was developed by Hirano et al. in 2013 for objective assessment of endoscopic findings: Edema, Rings, Exudates, Furrows, and Stricture are comprehensively assessed as major features. […] The optimal cutoff value for the ERERS score to predict EoE has not been determined. […] Endoscopists should also be aware that endoscopic disease activity by EREFS score does not correlate well with clinical symptoms or histological activity. […] Multiple biopsies are favorable to diagnose EoE more effectively, due to a heterogeneous distribution of intraepithelial eosinophil infiltration.

• #1 Diagnosis and Treatment of Eosinophilic Esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6986782/

  Eosinophilic esophagitis (EoE) is an eosinophil rich, Th2 antigen mediated disease of increasing pediatric and adult worldwide prevalence. Diagnosis requires greater than or equal to 15 eosinophils per high power field on light microscopy. […] EoE diagnosis rests on the presence of esophageal eosinophilia greater than or equal to 15 eosinophils per high power field under routine light microscopy following hematoxylin and eosin staining. […] The gold standard for EoE diagnosis remains the biopsy findings demonstrating increased intraepithelial esophageal eosinophils without concomitant eosinophilic infiltration in the stomach or duodenum. […] Since eosinophilic infiltration of the esophagus may not be evenly distributed, biopsies should be obtained from the proximal and distal esophagus to increase the diagnostic yield.

• #1 Eosinophilic esophagitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203

  Biopsy. During an endoscopy, a biopsy of your esophagus will be done. A biopsy involves taking a small bit of tissue. Multiple tissue samples will likely be taken from your esophagus and then examined under a microscope for eosinophils. […] Blood tests. If eosinophilic esophagitis is suspected, you may undergo some additional tests to confirm the diagnosis. These tests look for the sources of your allergic reaction, also called allergens. You may be given blood tests to look for higher than usual eosinophil counts or total immunoglobulin E levels, suggesting an allergy. […] Esophageal sponge. This test is performed in the health care provider’s office. It involves swallowing a capsule attached to a string. The capsule will dissolve in your stomach and release a sponge that the provider will pull out of your mouth with the string. As the sponge is pulled out, it will sample the esophageal tissues. This allows your provider to determine the degree of inflammation in your esophagus without an endoscopy.

• #1

  https://journals.lww.com/ajg/fulltext/2025/01000/acg_clinical_guideline__diagnosis_and_management.16.aspx

  Endoscopic evaluation is critical in EoE for diagnosis, assessing treatment response, and long-term monitoring of disease activity. […] We recommend using a systematic endoscopic scoring system (e.g., the EoE Endoscopic Reference Score [EREFS]) to characterize endoscopic findings of EoE at every endoscopy. […] We recommend obtaining at least 6 esophageal biopsies from at least 2 esophageal levels (e.g., proximal/mid and distal), targeting EoE endoscopic findings, if possible, to assess for histologic features consistent with EoE. […] We recommend that eosinophil counts be quantified on esophageal biopsies from every endoscopy performed for EoE. […] The goals of EoE treatment are to improve patient symptoms and quality of life, improve or normalize the endoscopic and histologic appearance of the esophagus, normalize growth and development in children, maintain nutrition, and prevent complications such as food impaction, esophageal stricturing, and perforation.

• #1 Diagnosis and management of eosinophilic oesophagitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/diagnosis-and-management-of-eosinophilic-oesophagitis.html

  Oesophageal biopsies are examined for the presence of raised eosinophils. The diagnostic threshold for eosinophilic oesophagitis is at least 15 eosinophils (60 eosinophils per mm2) per high-power field. […] The eosinophilic oesophagitis endoscopic reference score referred to as the mnemonic EREFS is used to grade the severity of eosinophilic oesophagitis based on scoring individual endoscopic features. The total score provides an overall assessment of severity and can be used to guide management and assess treatment response.

• #1 Eosinophilic esophagitis (EoE) Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/eosinophilic-esophagitis/diagnosis.html

  Eosinophilic Esophagitis (EoE) Diagnosis […] The best way to diagnose EoE is to examine a tissue sample (biopsy) under a microscope. […] The Esophagus Center offers advanced diagnostic tests, such as 24-hour esophageal studies and esophageal manometry, that help us learn more about the condition, so we can determine the best treatment. […] You may undergo one or more tests, including: […] 24-hour esophageal pH/impedance study: Using a tube with an acid (pH) sensor at the tip and impedance sensors throughout the catheter, this test measures acid and non-acid levels in your esophagus over a 24-hour period. […] Wireless reflux monitoring: During endoscopy, the doctor secures a small probe to the inner esophagus that measures acid reflux over 48 to 96 hours. […] Barium esophagram: This imaging study uses a special dye (barium) to show narrowing (stricture) and other abnormalities in your esophagus.

• #1 Eosinophilic esophagitis (EoE) Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/eosinophilic-esophagitis/diagnosis.html

  Esophageal manometry: By passing a small tube through your nose to your esophagus, this test measures pressure and muscle contractions. […] Impedance test: This test measures how liquid moves from your stomach to your esophagus. […] EndoFlip: We perform this test during endoscopy to measure diameter and amount of stretch throughout the esophagus. […] Upper endoscopy: We pass an endoscope (a thin, flexible tube with a lighted camera) through your mouth and esophagus and carefully examine the lining of your esophagus. We may also take a tissue sample and examine it under a microscope.

• #1 Eosinophilic Esophagitis

  https://www.aaaai.org/conditions-treatments/related-conditions/eosinophilic-esophagitis

  Allergists are experts in evaluating and treating EoE related to food allergies. However, the relationship between food allergy and EoE is complex. In EoE, it is more difficult to establish the role of foods because the reactions are delayed, and can develop over days, making it harder to pinpoint a specific food as the trigger. Foods such as dairy products, wheat, egg, and soy are recognized as the most common triggers for EoE. […] Once the causative food(s) is (are) identified and removed from a persons diet, esophageal inflammation and symptoms generally improve in a few weeks. Symptoms may not always reflect whether inflammation is present in the esophagus so additional biopsies are necessary to see if a diet is working and prove which food(s) is (are) causing EoE.

• #1 Diagnosis and Treatment of Eosinophilic Esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6986782/

  At least five biopsies should be obtained at multiple esophageal levels to maximize the sensitivity based on a diagnostic threshold of 15 eosinophils per high power field. […] The presence of eosinophilia is the key factor for a diagnosis of primary EoE so it is essential to rule out secondary causes of esophageal eosinophilia. […] While histologic assessment is the gold standard in diagnosing in EoE, there have been cases in which patients with a high pretest probability of EoE have had biopsies which do not meet the diagnostic eosinophil threshold for EoE. […] The EoE diagnostic panel (EDP) is a molecular tool which may help further identify and risk stratify patients. This test assesses the expression of 96 genes that are dysregulated in EoE and has high sensitivity and specificity for diagnosis.

• #1

  https://journals.lww.com/ajg/fulltext/2025/01000/acg_clinical_guideline__diagnosis_and_management.16.aspx

  Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus. It is diagnosed in the setting of symptoms of esophageal dysfunction and an eosinophilic predominant infiltrate in the esophagus. […] Over the past decade, there have been paradigm shifts in disease diagnosis and management, increases in knowledge about EoE risk factors, natural history, and pathogenesis, and development of validated outcome metrics. […] This updated American College of Gastroenterology Clinical Guideline uses Grading of Recommendations, Assessment, Development, and Evaluation methodology to make recommendations across domains of diagnosis, treatment, monitoring and assessment of response, and pediatric-specific considerations. […] We recommend that EoE is diagnosed based on the presence of symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy, after evaluating for non-EoE disorders that cause or potentially contribute to esophageal eosinophilia.

• #1 Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances

  https://www.mdpi.com/2075-4418/12/12/3202

  Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease, characterized by esophageal dysfunction and intense eosinophil infiltration localized in the esophagus. […] EoE is a clinicopathological disease for which the histological demonstration of esophageal eosinophilia is essential for diagnosis. Therefore, the recognition of the characteristic endoscopic features with subsequent biopsy are critical for early definitive diagnosis and treatment, in order to prevent complications. […] EoE is diagnosed based on the presence of clinical symptoms and histologically-proven esophageal eosinophilia with a peak of ≥15 eosinophils/hpf (~60 eosinophils/mm²), excluding diseases and conditions inducing secondary esophageal eosinophilia such as EGE, hyper eosinophilic syndrome, drug-induced esophagitis or achalasia.

• #1

  https://journals.lww.com/ajg/fulltext/2025/01000/acg_clinical_guideline__diagnosis_and_management.16.aspx

  Although the diagnostic approach to EoE has evolved since the first guidelines in 2007, the conceptual definition of the condition is the same: EoE is an allergen/immune-mediated clinicopathologic condition characterized clinically by symptoms of esophageal dysfunction and histopathologically by a marked esophageal eosinophilic infiltrate. […] The current diagnostic criteria were established by international consensus during the AGREE (A Working Group on PPI-REE) Conference and are reinforced by other guideline-making bodies; we reinforce that consensus here. […] EoE is diagnosed with the following 3 criteria: (i) symptoms of esophageal dysfunction; (ii) at least 15 eos/hpf on esophageal biopsy; and (iii) an evaluation for non-EoE disorders that cause or potentially contribute to esophageal eosinophilia.

• #1 Gastroesophageal Reflux Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0301/p1161.html

  Gastroesophageal reflux disease (GERD) can usually be diagnosed based on the clinical presentation alone. […] In the absence of classic symptoms, GERD becomes more difficult to diagnose. […] Diagnostic tests are used when the diagnosis is in doubt or complications are a concern. […] A recent study demonstrated a potential role for a proton pump inhibitor, omeprazole (Prilosec), in the diagnosis of GERD. […] Endoscopy is useful for diagnosing the complications of GERD, such as Barrett’s esophagus, esophagitis and strictures, but it is not sensitive for diagnosis of GERD itself. […] Ambulatory pH monitoring is generally considered the diagnostic gold standard for use in patients with GERD.

• #1 Esophagitis Workup: Approach Considerations, Laboratory Studies, Esophageal Barium Studies (Esophagography)

  https://emedicine.medscape.com/article/174223-workup

  EGD is preferred in patients with odynophagia because this is a specific symptom of esophagitis. EGD is the main diagnostic tool used for esophagitis. As noted earlier, upper endoscopy should be thought of as complementary to, rather than competing with, barium studies in the evaluation of patients with dysphagia. […] Histologic findings of esophagitis vary according to the etiology. For example, fungal and viral infections occur at differing locations in esophagitis-associated ulcers. […] The diagnosis of herpes simplex virus (HSV) esophagitis is made at endoscopy. […] Diagnosis depends on biopsies obtained by esophagogastroduodenoscopy (EGD). […] Tissue is needed for confirmation of the diagnosis; obtain multiple biopsies from the ulcer base. […] Endoscopy is required to exclude cytomegalovirus as the cause of this finding before treating patients.

• #1 Esophagitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK442012/

  The endoscopic appearance of the mucosal lesions can help with diagnosis. In patients with suspected eosinophilic esophagitis, endoscopy may reveal white exudates or papules, red furrows, corrugated concentric rings, and strictures; but endoscopy may be normal in up to 10% of patients. Endoscopic signs of candidiasis are small, diffuse, linear, yellow-white „cheese-like” plaques adherent to the mucosa. CMV esophagitis is characterized by several large, shallow, superficial ulcerations. HSV esophagitis results in multiple small, deep ulcerations. […] Endoscopic biopsy of esophageal lesion histology study can differentiate and confirm different esophagitis etiology. Patients with eosinophilic esophagitis on histology will have a characteristic eosinophilic infiltration (15 eosinophils per high-power field). Histology can also be helpful in the diagnosis of infectious etiologies. Multinucleated giant cells with ballooning and degeneration of squamous cells are diagnostic of HSV esophagitis with Cowdry type A inclusions being pathognomonic. Large cells with both intracytoplasmic inclusions and amphophilic intranuclear inclusions are suggestive of CMV esophagitis.

• #1 Ogden Esophagitis Diagnosis & Treatment | Douglas Anderson, MD

  https://www.dougandersonent.com/esophagitis

  Eosinophilic esophagitis: Eosinophils are a type of white blood cell that play a key role in allergic reactions. When eosinophilic esophagitis occurs, it is generally a response to acid reflux, an allergy-causing agent, or both. […] Drug-induced esophagitis: Many types of oral medications can cause esophagitis, especially when they are taken without water as the residue of the pill can remain in the esophagus. If you believe your condition is esophagitis, reach out to Douglas Anderson, MD to schedule your appointment in Ogden.

• #1 Eosinophilic Esophagitis: The Challenging Journey to Diagnosis

  https://www.hcplive.com/view/eosinophilic-esophagitis-the-challenging-journey-to-diagnosis

  For many patients, the road to an Eosinophilic Esophagitis (EoE) diagnosis can be a long, difficult journey. As a disease that is growing in prevalence, EoE is a chronic, immune-mediated inflammatory disease localized in the esophagus. While the exact cause of EoE is unknown, researchers believe several variables play a role, including genetics, environmental factors, immune system dysfunction and atopy. […] Earlier detection is important as it can help reduce a patients potential risk of disease complications. However, identifying EoE can be complex and delayed diagnosis is common among patients, up to eight years on average for adults according to one systematic review. Several factors can contribute to these delays. EoE can be under-recognized among specialists. Symptoms may also be under-reported by patients around 50 percent of dysphagia cases may not be discussed with a physician, yet its the most common symptom of EoE. Additionally, EoE symptoms can mimic other more common diseases such as gastroesophageal reflux disease (GERD) and patients can also present with one or more atopic disorders, such as asthma, rhinitis, atopic dermatitis and food allergies, making it challenging to assess and diagnose.

• #1 Approach to Diagnosis of Eosinophilic Esophagitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/november-2011/approach-to-diagnosis-of-eosinophilic-esophagitis/

  The next step is to perform an endoscopy to evaluate the symptoms and obtain esophageal biopsies in order to demonstrate infiltration of eosinophils in the esophageal epithelium. Currently, at least 15 eosinophils in at least 1 high-power microscopy field are needed to consider the diagnosis of EoE, and other histopathologic findings, such as eosinophilic microabscesses or fibrosis of the lamina propria, should also be considered. […] The final step is to make sure that the esophageal eosinophilia is not explained by another condition, such as gastroesophageal reflux disease (GERD), eosinophilic gastroenteritis, Crohn’s disease, achalasia, connective tissue disorders, parasitic infections, hypereosinophilic syndrome, or drug hypersensitivity. There is still controversy regarding how to exclude or separate reflux from EoE. Many physicians believe that when a patient has symptoms and biopsy findings suggestive of EoE, a trial of proton pump inhibitor (PPI) therapy (twice-daily dosing for at least 8 weeks) should be administered to see if the patient improves. A formal diagnosis of EoE is typically given only if the patient has persistent symptoms and esophageal eosinophilia after the PPI trial. However, the updated guidelines recognize a subgroup of patients who may clinically appear to have EoE and not reflux but who experience a complete symptomatic and histologic response to PPI therapy. This new category has been called PPI-responsive esophageal eosinophilia. This is an active area of research and debate, as little is currently known regarding the features of these patients.

• #1 An Evolving Approach to the Diagnosis of Eosinophilic Esophagitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/june-2018/an-evolving-approach-to-the-diagnosis-of-eosinophilic-esophagitis/

  Currently, the diagnosis of EoE requires upper endoscopy with multiple biopsies of esophageal mucosa, and management requires repeat upper endoscopies to assess mucosal and histologic response to treatment. […] The development of less invasive tests to predict or monitor EoE would allow for selective testing in high-risk patients and reduce the number of endoscopies performed, which would also allow for a more cost-effective method of caring for patients with EoE. […] With the rise of molecular technology, a gene expression panel (the EoE diagnostic panel; EDP) that comprises 94 genes was developed and has the ability to detect pediatric and adult patients with EoE with a 96% sensitivity and 98% specificity. […] Although the EDP or tissue biomarkers still require upper endoscopy with biopsies, these tests could potentially increase diagnostic accuracy and reduce the number of biopsies needed.

• #2 Esophagitis: Causes, Symptoms, & Treatments

  https://www.webmd.com/digestive-disorders/esophagitis

  Esophagitis Diagnosis […] Once your doctor has done a physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include: […] Upper endoscopy […] A test in which a long, flexible lighted tube, called an endoscope, is used to view your esophagus. […] Esophageal sponge […] In this test, you swallow a capsule that has a string attached. In your stomach, the capsule dissolves, releasing a sponge. Your doctor pulls the sponge up by the string, and the sponge takes samples of your tissue as it comes out. The sample then is checked by a lab. This procedure lets you skip an endoscopy. […] Biopsy […] During this test, a small sample of the esophageal tissue is removed and then sent to a lab to be checked under a microscope. […] Upper GI series (or barium swallow) […] During this procedure, X-rays are taken of the esophagus after you drink a barium solution. Barium coats the lining of your esophagus and shows up white on an X-ray. This lets doctors see problems in your esophagus.

• #2 Esophagitis – Harvard Health

  https://www.health.harvard.edu/a_to_z/esophagitis-a-to-z

  The diagnosis often is made based on your symptoms. […] The most accurate way to check for esophagitis is for a doctor to look directly at the inside of the esophagus with a video camera called an endoscope. The endoscope has a camera at the end of a flexible, plastic-coated cord. This tube is long enough to reach through the stomach to the first portion of the intestine (duodenum). The procedure is sometimes called esophagogastroduodenoscopy or EGD. […] Using the endoscope, the doctor can see evidence of injury from esophagitis. The doctor will look for areas where the lining of the esophagus has worn away (called erosions or ulcers), blisters, or scarred areas. Some infections leave a deposit on the esophagus walls that can be sampled through the endoscope by using a remote-controlled brush. In some cases the doctor will biopsy the esophagus by snipping a small sample of the inside lining through the end of the endoscope. This tissue is examined under a microscope. […] Since esophagitis is only one of the things that can cause symptoms of chest pain or swallowing problems, your doctor may order other tests to evaluate your heart, lungs, or digestive tract.

• #2 Esophagitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK442012/

  The endoscopic appearance of the mucosal lesions can help with diagnosis. In patients with suspected eosinophilic esophagitis, endoscopy may reveal white exudates or papules, red furrows, corrugated concentric rings, and strictures; but endoscopy may be normal in up to 10% of patients. Endoscopic signs of candidiasis are small, diffuse, linear, yellow-white „cheese-like” plaques adherent to the mucosa. CMV esophagitis is characterized by several large, shallow, superficial ulcerations. HSV esophagitis results in multiple small, deep ulcerations. […] Endoscopic biopsy of esophageal lesion histology study can differentiate and confirm different esophagitis etiology. Patients with eosinophilic esophagitis on histology will have a characteristic eosinophilic infiltration (15 eosinophils per high-power field). Histology can also be helpful in the diagnosis of infectious etiologies. Multinucleated giant cells with ballooning and degeneration of squamous cells are diagnostic of HSV esophagitis with Cowdry type A inclusions being pathognomonic. Large cells with both intracytoplasmic inclusions and amphophilic intranuclear inclusions are suggestive of CMV esophagitis.

• #2 Tests to Detect and Treat Esophageal Disorders

  https://www.northlakegastro.com/tests-to-detect-and-treat-esophageal-disorders

  The diagnosis of esophageal disorders usually involves a combination of patient history, physical examination, and diagnostic tests. Here are some of the most common diagnostic tests for esophageal disorders. […] EGD is a diagnostic procedure in which a flexible tube with a light and camera is inserted through the mouth into the esophagus, stomach, and duodenum. This test allows the doctor to visually examine the lining of the esophagus and stomach for any abnormalities such as inflammation, ulcers, or tumors. EGD can also be used to take tissue samples (biopsies) for further analysis. […] A barium swallow test is a diagnostic imaging test that involves swallowing a liquid containing barium, a contrast material that shows up on X-rays. This test allows the doctor to visualize the esophagus as the barium passes through it, highlighting any abnormalities such as strictures (narrowing) or diverticula (outpouching).

• #2 Diagnosis of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/diagnosis-of-eosinophilic-esophagitis/?srsltid=AfmBOopq5oh42s9vjgEKIbmHP4Vapm1pyCBXoatfo0Q5w_tKAJfC1cFe

  Children with EoE can present with a wide range of symptoms. […] Given the broad differential diagnosis associated with these common pediatric symptoms, suspicion for EoE should be raised for any child with abnormal presentation or associated comorbid allergic conditions. Broadly, symptoms of EoE and evidence of esophageal dysfunction include: Dysphagia, Recurrent emesis, Recurrent or chronic abdominal pain, Reflux. […] Symptoms can vary according to the age of the child. […] EoE cannot be established or excluded based upon the macroscopic appearance of the esophagus. […] A lack of abnormal endoscopic findings does not rule out EoE as a diagnosis. Eosinophilia may still be present, and a biopsy should be performed even in the absence of typical endoscopic findings of EoE. […] Tissue samples should always be obtained during endoscopy because histologic examination of the samples is required for diagnosis and for treatment follow up.

• #2 Diagnosis and Treatment of Eosinophilic Esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6986782/

  At least five biopsies should be obtained at multiple esophageal levels to maximize the sensitivity based on a diagnostic threshold of 15 eosinophils per high power field. […] The presence of eosinophilia is the key factor for a diagnosis of primary EoE so it is essential to rule out secondary causes of esophageal eosinophilia. […] While histologic assessment is the gold standard in diagnosing in EoE, there have been cases in which patients with a high pretest probability of EoE have had biopsies which do not meet the diagnostic eosinophil threshold for EoE. […] The EoE diagnostic panel (EDP) is a molecular tool which may help further identify and risk stratify patients. This test assesses the expression of 96 genes that are dysregulated in EoE and has high sensitivity and specificity for diagnosis.

• #2

  https://journals.lww.com/ajg/fulltext/2025/01000/acg_clinical_guideline__diagnosis_and_management.16.aspx

  Endoscopic evaluation is critical in EoE for diagnosis, assessing treatment response, and long-term monitoring of disease activity. […] We recommend using a systematic endoscopic scoring system (e.g., the EoE Endoscopic Reference Score [EREFS]) to characterize endoscopic findings of EoE at every endoscopy. […] We recommend obtaining at least 6 esophageal biopsies from at least 2 esophageal levels (e.g., proximal/mid and distal), targeting EoE endoscopic findings, if possible, to assess for histologic features consistent with EoE. […] We recommend that eosinophil counts be quantified on esophageal biopsies from every endoscopy performed for EoE. […] The goals of EoE treatment are to improve patient symptoms and quality of life, improve or normalize the endoscopic and histologic appearance of the esophagus, normalize growth and development in children, maintain nutrition, and prevent complications such as food impaction, esophageal stricturing, and perforation.

• #2 Esophagitis: Types, Symptoms, Causes, Diagnosis, Treatment

  https://www.health.com/esophagitis-overview-7495960

  To diagnose esophagitis, your healthcare provider will review your medical history, ask about your symptoms, and perform a physical exam. They may order diagnostic tests to confirm the diagnosis, determine its cause, and guide appropriate treatment decisions. […] A flexible tube with a camera (endoscope) is inserted through the mouth to examine the esophagus, stomach, and upper part of the small intestine. This procedure lets your healthcare provider (usually a gastroenterologist) visualize your esophagus and look for signs of inflammation and swelling. […] During the endoscopy, your healthcare provider may remove a small tissue sample from the esophagus and send it to the lab for further analysis. […] For this procedure, you will drink a chalky liquid containing barium, which coats the esophagus and makes it easier to view on X-ray images. […] A thin tube is inserted through the nose and passed through the esophagus to measure how well your esophagus functions while you swallow.

• #2 Tests to Detect and Treat Esophageal Disorders

  https://www.northlakegastro.com/tests-to-detect-and-treat-esophageal-disorders

  PH monitoring is a diagnostic test that measures the acidity (pH) in the esophagus over a period of time. This test is typically used to diagnose GERD, as it can detect abnormal acid reflux even when patients don’t have symptoms. […] High-resolution manometry is a diagnostic test that evaluates the function of the esophageal muscles and how they contract to move food and liquids into the stomach. […] Endoscopic ultrasound (EUS) is a diagnostic procedure that combines an endoscope (a flexible tube with a light and camera) and ultrasound technology. EUS allows doctors to visualize and evaluate the layers of the esophagus and surrounding tissues in high detail. […] To sum it up, there are several diagnostic tests available for the evaluation of esophageal disorders. Esophagogastroduodenoscopy (EGD) is the gold standard for visualizing the esophagus and taking biopsies. pH monitoring and high-resolution manometry can help diagnose motility disorders and GERD. Endoscopic ultrasound (EUS) provides detailed imaging of the esophageal wall and surrounding tissues and is useful for diagnosing esophageal cancer and other conditions. Your healthcare provider can help determine which diagnostic test is right for you based on your symptoms and medical history.

• #2 An Evolving Approach to the Diagnosis of Eosinophilic Esophagitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/june-2018/an-evolving-approach-to-the-diagnosis-of-eosinophilic-esophagitis/

  An even less invasive assessment of the esophageal mucosa can be achieved via the Esophageal String Test (EST; EnteroTrack) and Cytosponge (University of Cambridge) test. […] Based on the current understanding of EoE pathogenesis, investigators have evaluated a number of potential serologic biomarkers, including absolute eosinophil count, as well as specific cytokines (eg, IL-4, IL-5, IL-13) and chemokines (eg, eotaxin-3, eosinophil granule proteins, mast cell tryptase) to establish a diagnosis of EoE and to monitor the condition. […] However, although panels of these biomarkers have been created, none have been validated or are being used in the clinical setting. […] These should further streamline and simplify EoE diagnosis, allowing patients to benefit and move from diagnosis to treatment.

• #2 Eosinophilic Esophagitis (EoE) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/eosinophilic-esophagitis

  If you think that your child may have eosinophilic esophagitis, contact your primary care physician. He or she may then refer you either to a pediatric gastroenterologist or allergist for further evaluation. […] The only way to diagnose EoE is by a biopsy of the esophagus, performed by a gastroenterologist. The child is sedated and the physician inserts an endoscope into the mouth and through the esophagus, stomach and upper part of the small intestine, where a small sample of tissue is taken. […] Sometimes, the gastroenterologist can see signs of EoE in the esophagus, such as „rings” or „white plaques.” However, in many cases a child can have EoE and esophageal tissue that appears to be normal. Therefore, it is critical to obtain an esophageal biopsy sample. […] Typical allergy tests, such as skin or blood tests that identify immediate allergic reactions, are not usually effective for diagnosis of eosinophilic esophagitis because the allergic reacting involved in EoE is often delayed several days after an allergen is introduced. […] Skin patch test is often more insightful, but is not routinely offered by most allergists. Both tests are guidelines on how to introduce foods but like all tests nothing is 100 percent predictive.

• #2 An Evolving Approach to the Diagnosis of Eosinophilic Esophagitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/june-2018/an-evolving-approach-to-the-diagnosis-of-eosinophilic-esophagitis/

  Currently, the diagnosis of EoE requires upper endoscopy with multiple biopsies of esophageal mucosa, and management requires repeat upper endoscopies to assess mucosal and histologic response to treatment. […] The development of less invasive tests to predict or monitor EoE would allow for selective testing in high-risk patients and reduce the number of endoscopies performed, which would also allow for a more cost-effective method of caring for patients with EoE. […] With the rise of molecular technology, a gene expression panel (the EoE diagnostic panel; EDP) that comprises 94 genes was developed and has the ability to detect pediatric and adult patients with EoE with a 96% sensitivity and 98% specificity. […] Although the EDP or tissue biomarkers still require upper endoscopy with biopsies, these tests could potentially increase diagnostic accuracy and reduce the number of biopsies needed.

• #2

  https://journals.lww.com/ajg/fulltext/2025/01000/acg_clinical_guideline__diagnosis_and_management.16.aspx

  Although the diagnostic approach to EoE has evolved since the first guidelines in 2007, the conceptual definition of the condition is the same: EoE is an allergen/immune-mediated clinicopathologic condition characterized clinically by symptoms of esophageal dysfunction and histopathologically by a marked esophageal eosinophilic infiltrate. […] The current diagnostic criteria were established by international consensus during the AGREE (A Working Group on PPI-REE) Conference and are reinforced by other guideline-making bodies; we reinforce that consensus here. […] EoE is diagnosed with the following 3 criteria: (i) symptoms of esophageal dysfunction; (ii) at least 15 eos/hpf on esophageal biopsy; and (iii) an evaluation for non-EoE disorders that cause or potentially contribute to esophageal eosinophilia.

• #2 Eosinophilic Esophagitis (EoE): Diagnosis and Monitoring for HCPs

  https://www.seeeoe.com/

  Due to the patchy nature of the disease, some patients with EoE can present with normal endoscopic findings. Endoscopies can miss complications, such as strictures, caused by chronic inflammation in EoE. Endoscopic findings should be assessed in conjunction with symptoms and histopathology. […] The guidelines from the 2017 AGREE conference indicate that an eosinophil count of 15/HPF (high-power field) in at least one of multiple esophageal biopsy samples taken from different locations is clinically indicative of EoE. The presence of esophageal eosinophilia alone, however, cannot establish an EoE diagnosis without further investigation of symptoms and endoscopy. […] Investigate all 3 domains of EoE to reduce delays in diagnosis and help manage EoE over time. According to the 2018 updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis from the AGREE Conference, PPIs are no longer a tool to diagnose EoE.

• #2 Esophagitis Differential Diagnoses

  https://emedicine.medscape.com/article/174223-differential

  In the appropriate clinical setting, discrete superficial ulcers in the upper or mid esophagus without associated plaques should be highly suggestive of herpes esophagitis. In contrast, ulceration in Candida esophagitis almost invariably occurs on a background of extensive plaque formation. […] Because herpetic ulcers rarely become as large as those of infectious esophagitis, the presence of one or more giant ulcers suggests the possibility of cytomegalovirus (CMV) esophagitis in patients with AIDS. However, in patients who are positive for human immunodeficiency virus (HIV), giant esophageal ulcers can also be caused by HIV. […] Because most HIV ulcers are indistinguishable from CMV ulcers on the basis of the clinical and radiographic criteria, CMV esophagitis must be excluded by means of endoscopy before a diagnosis of HIV esophagitis can be established.

• #2 Getting A Eosinophilic Esophagitis Diagnosis

  https://resources.healthgrades.com/right-care/allergies/why-eosinophilic-esophagitis-can-be-difficult-to-diagnose

  Eosinophilic esophagitis (EoE) can be hard to diagnose because no single test can confirm EoE symptoms. EoE can also share symptoms of gastroesophageal reflux disease (GERD). Distinguishing between these conditions and others can help with treatment. […] Your doctor can diagnose EoE by reviewing your symptoms and checking the esophagus for signs of inflammation and a buildup of white blood cells. Additional testing may be necessary to rule out other conditions. […] Diagnosing EoE may include the following steps: reviewing symptoms, performing imaging and a biopsy of the esophagus, ruling out other possible causes of your symptoms. […] If your symptoms and medical history suggest an EoE diagnosis, your doctor may suggest you have an upper endoscopy. […] During this procedure, your doctor can guide a thin, flexible tube down the throat and into the esophagus. The tube has a tiny camera at one end that can send images of the esophageal lining to a monitor. Your doctor can look for signs of inflammation.

• #2 Eosinophilic Esophagitis: What it Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14321-eosinophilic-esophagitis

  Treatment focuses on managing the inflammation in your esophagus. […] Your gastroenterologist will order upper endoscopies with biopsy to confirm treatment is reducing inflammation. […] A diagnosis of eosinophilic esophagitis may come as a relief, particularly if youve had symptoms for years without knowing the cause.

• #2 A Practical Approach to Diagnosis and Management of Eosinophilic Esophagitis | MDedge

  https://mdedge.com/gihepnews/article/272483/upper-gi-tract/practical-approach-diagnosis-and-management-eosinophilic-esophagitis

  Second, at least 15 eosinophils per high-power field (eos/hpf) are required on esophageal biopsy, which implies that an endoscopy be performed. […] The third and final step in diagnosis is assessing for other conditions that could cause esophageal eosinophilia. The most common differential diagnosis is gastroesophageal reflux disease (GERD). […] After the diagnosis is established, there should be direct communication with the patient to review the diagnosis and select treatments. […] After initial treatment, it is critical to assess for treatment response. Goals of EoE treatment include improvement in symptoms, but also improvement in endoscopic and histologic features to prevent complications. […] Because of this, performing a follow-up endoscopy after initial treatment is guideline-recommended.

• #2 A Practical Approach to Diagnosis and Management of Eosinophilic Esophagitis | MDedge

  https://mdedge.com/gihepnews/article/272483/upper-gi-tract/practical-approach-diagnosis-and-management-eosinophilic-esophagitis

  Eosinophilic esophagitis (EoE) can be considered a “young” disease, with initial case series reported only about 30 years ago. […] The most likely area that you will encounter EoE is during an emergent middle-of-the-night endoscopy for food impaction. If called in for this, EoE will be the cause in more than 50% of patients. However, the diagnosis can only be made if esophageal biopsies are obtained at the time of the procedure. This is a critical time to decrease diagnostic delay, as half of patients are lost to follow-up after a food impaction. […] The next most likely area for EoE detection is in the endoscopy suite where 15-23% of patients with dysphagia and 5-7% of patients undergoing upper endoscopy for any indication will have EoE. […] Diagnosis of EoE is based on the AGREE consensus, which is also echoed in the recently updated American College of Gastroenterology (ACG) guidelines. Diagnosis requires three steps. First, symptoms of esophageal dysfunction must be present. This will most typically be dysphagia in adolescents and adults, but symptoms are non-specific in children (e.g. poor growth and feeding, abdominal pain, vomiting, regurgitation, heartburn).

• #2 Approach to Diagnosis of Eosinophilic Esophagitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/november-2011/approach-to-diagnosis-of-eosinophilic-esophagitis/

  G&H What do you foresee in terms of future diagnostic strategies? […] ESD I foresee a shift toward tissue biomarkers and, possibly, blood tests for diagnosis of EoE. Several publications have looked at different biopsy staining techniques to highlight eosinophils and demonstrate eosinophil activation (by looking at specific eosinophil granules that are released), and other studies have quantified elevated levels of inflammatory cytokines in the esophageal mucosa. There have also been studies looking at ancillary cell types (eg, mast cells) that could help to distinguish EoE from GERD. All of these studies hold promise for streamlining the diagnostic process, although these methods still need to be prospectively validated. […] Another area currently being investigated is gene transcription analysis. The set of genes transcribed in EoE has been described in pediatric patients, and there is a clear signal of upregulated and downregulated genes. Researchers are currently in the process of validating this technique as a diagnostic test.

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