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Esophagitis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

A complete blood count (CBC) is performed in patients with neutropenia or who are immunosuppressed. A CD4 count and HIV test are performed in patients with risk factors for HIV. A collagen workup (eg, antinuclear antibody [ANA], anti-dsDNA) may be performed based on the underlying disease.

Laboratory Findings

Eosinophilic Esophagitis

Laboratory findings of the EoE are as follows:[1][2][3][4][5][6]

  • There are no specific diagnostic markers to diagnose EoE patients.
  • Although not specific, elevated serum IgE level is identified in majority patients.
  • Increased peripheral eosinophil count is also seen in the majority of patients.
  • There are 3 main ways in which food allergies can be detected in EoE are as follows:
Test Procedure Interpretation
Skin prick testing A small amount of allergen is introduced into the skin of the patient through a gentle puncture with a pricking device.
  • An area of redness and swelling around the prick.
Atopy patch testing
  • A small amount of a fresh food in a small aluminum chamber called a Finn chamber.
  • The Finn chamber is then taped on the person’s back.
  • The food in the chamber stays in contact with the skin for 48 hours.
  • It is then removed and the allergist reads the results at 72 hours.
  • The results from the food patch test helps the physician to determine which foods can be avoided
  • A positive delayed reaction to the food is determined by the inflamed area of the skin around the Finn chamber.
  • This is more useful in the pediatric population than in the adults.

Reflux Esophagitis

Ambulatory reflux monitoring

  • GERD is mostly diagnosed clinically by the presenting typical symptoms which include heartburn, regurgitation, and dysphagia.
  • Correlation of the GERD symptoms with confirmed acid presence by the ambulatory reflux monitoring is strongly suggestive of GERD.
  • Ambulatory reflux monitoring is recommended by the American College of Gastroenterology (ACG) as the only laboratory test to determine the presence of acidic reflux in the esophagus.[7]
  • Indications of ambulatory reflux monitoring include the following:[8]
    • GERD diagnosis if it is not confirmed
    • Determine the time of reflux occurrence
    • Refractory GERD symptoms
    • Preoperative for non-erosive disease
  • Ambulatory reflux monitoring is performed in either two ways which include:
    • Telemetry capsule (48 hours monitoring)
    • Transnasal catheter (24 hours monitoring)

References

  1. ↑ Roy-Ghanta S, Larosa DF, Katzka DA (2008). “Atopic characteristics of adult patients with eosinophilic esophagitis”. Clin. Gastroenterol. Hepatol. 6 (5): 531–5. doi:10.1016/j.cgh.2007.12.045. PMID 18304887.
  2. ↑ Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA (2010). “Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis”. Ann. Allergy Asthma Immunol. 104 (6): 496–502. doi:10.1016/j.anai.2010.03.018. PMID 20568382.
  3. ↑ Dellon ES, Gibbs WB, Fritchie KJ, Rubinas TC, Wilson LA, Woosley JT, Shaheen NJ (2009). “Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease”. Clin. Gastroenterol. Hepatol. 7 (12): 1305–13, quiz 1261. doi:10.1016/j.cgh.2009.08.030. PMID 19733260.
  4. ↑ Chehade M, Sampson HA (2008). “Epidemiology and etiology of eosinophilic esophagitis”. Gastrointest. Endosc. Clin. N. Am. 18 (1): 33–44, viii. doi:10.1016/j.giec.2007.09.002. PMID 18061100.
  5. ↑ Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ (2007). “Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review”. Am. J. Gastroenterol. 102 (10): 2300–13. doi:10.1111/j.1572-0241.2007.01396.x. PMID 17617209.
  6. ↑ Aceves SS, Newbury RO, Dohil R, Schwimmer J, Bastian JF (2007). “Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder”. J. Clin. Gastroenterol. 41 (3): 252–6. doi:10.1097/01.mcg.0000212639.52359.f1. PMID 17426462.
  7. ↑ Katz PO, Gerson LB, Vela MF (2013). “Guidelines for the diagnosis and management of gastroesophageal reflux disease”. Am J Gastroenterol. 108 (3): 308–28, quiz 329. doi:10.1038/ajg.2012.444. PMID 23419381.
  8. ↑ Katz PO, Gerson LB, Vela MF (2013). “Guidelines for the diagnosis and management of gastroesophageal reflux disease”. Am J Gastroenterol. 108 (3): 308–28, quiz 329. doi:10.1038/ajg.2012.444. PMID 23419381.

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