View source for Eosinophilic esophagitis differential diagnosis

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{{Eosinophilic esophagitis}}

==Overview==

==Differential Diagnosis==
==Differential Diagnosis==
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01=Dysphagia}}
{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | }}
{{familytree | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | | B02 | |B01=Oropharyngeal dysphagia|B02=Esophageal dysphagia|}}
{{familytree | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
{{familytree | | | | | | | C01 | | | | | | | | | | | | | C02 | | | | | | | | | | | C03 | | | | | | | | | | C04 | |C01=Solids only|C02=Solids and Liquids|C03=Solids only|C04=Solids and Liquids|}}
{{familytree | | | | | | | |!| | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | |!| | | | | | | | | | | |!| | | |}}
{{familytree | | | | | | | D01 | | | | | | | | | | D02 | | | | D03 | | | | | | | | D04 | | | | | | | | | | D05 | | |D01=•Zenker's diverticulum<br>•Neoplasm<br>•Webs |D02=Neurogenic|D03=Myogenic|D04=Pain|D05=•Achalasia<br>•Scleroderma<br>•DES|}}
{{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | |!| | | | | | |,|-|-|^|-|-|-|.| | | | | | | |!| | | |}}
{{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | E01 | | | | | E02 | | | | | E03 | | | | | | E04 | |E01=•Myasthenia gravis<br>•Connective tissue disorder<br>•Myotonic dystrophy|E02=No|E03=Yes|E04=Heart burn|}}
{{familytree | | | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | |!| | | | | | |!| | | | |,|-|-|^|-|-|.| |F01=Barium swallow|F02=Mental status|}}
{{familytree | | | | | | | |!| | | | | | | | |,|-|-|^|-|-|.| | | | | | |,|-|-|^|-|-|.| | | G01 | | | G02 | | | | G03 | |G01=•Pill esophagitis<br>•Caustic injury<br>•Chemotherapy|G02=Yes|G03=No|}}
{{familytree | | |,|-|-|-|-|+|-|-|-|-|.| | | H01 | | | | H02 | | | | | H03 | | | | H04 | | | | | | | |!| | | | | |!| | |H01=Impaired|H02=Normal|H03=Non progressive|H04=Progressive|}}
{{familytree | | I01 | | | I02 | | | I03 | | |!| | | | | |!| | | | | | |!| | | | | |!| | | | | | | | I04 | | | | I05 |  I01=Sac|I02=Webs|I03=Mass|I04=Scleroderma|I05=•Achalasia<br>•DES|}}
{{familytree | | |!| | | | |!| | | | |!| | | J01 | | | | J02 | | | | | J03 | | | | J04 | | | | | | | | | | | | | |!| |J01=Stroke|J02=•ALS<br>•Parkinsonism| J03=•Rings<br>•Webs|J04=•Strictures<br>•Cancer|}}
{{familytree | | K01 | | | K02 | | | K03 | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | | | | | | | K04 |K01=Zenker's diverticulum|K02=Plummer-Vinson syndrome|K03=Carcinoma|K04=Chest pain and manometry|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | | L02 | | | | | | | | | | | | | |!| |L01=Barium swallow|L02=Weight loss|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | |!| | | | | | | | | | | | | | M01 | |M01=Increase LES pressure|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | N01 | | | | N02 | |!| | | | | | | | | | | |,|-|-|^|-|-|.| |N01=Rings|N02=Webs|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | O01 | | | | O02 | | |O01=Yes|O02=No|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | P01 | | | | P02 | | | | | | | |!| | | | | |!| | P01=Rapid|P02=Slow|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | Q01 | | | | Q02 | |Q01=Achalasia|Q02=DES|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | R02 | | | | | | |R01=Cancer|R02=Strictures/GERD|}}
{{familytree/end}}


Eosinophilic esophagitis must be differentiated from other diseases that cause dysphagia such as [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[esophageal spasm]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]].<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref><ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref><ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref><ref name="pmid28943381">{{cite journal |vauthors=Matsuura H |title=Diffuse Esophageal Spasm: Corkscrew Esophagus |journal=Am. J. Med. |volume= |issue= |pages= |year=2017 |pmid=28943381 |doi=10.1016/j.amjmed.2017.08.041 |url=}}</ref><ref name="pmid1736462">{{cite journal |vauthors=Lassen JF, Jensen TM |title=[Corkscrew esophagus] |language=Danish |journal=Ugeskr. Laeg. |volume=154 |issue=5 |pages=277–80 |year=1992 |pmid=1736462 |doi= |url=}}</ref><ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref><ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref>

{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs and Symptoms
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard
|-
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
| colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Dysphagia
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Mental status
|-
| align="center" style="background:#4479BA; color: #FFFFFF;" |Solids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]]
|
* Gradual
| +
| -
|Non progressive
| +/-
| -
|
* [[Glossitis]]

* [[Koilonychia]]

|Normal
|
* Thin projections on the anterior [[esophageal]] wall
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
| 
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings

|
Triad of 
* [[Iron deficiency anemia]]
* [[Esophageal webs]]
* [[Glossitis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]] 
|
* Gradual

* Sudden onset
| +
| -
|Progressive
| +/-
| +/-
|
* [[Odynophagia]]
* [[Cough]]

* [[Chest pain]]
|Normal
|
*Sacculations
*Fixed transverse folds
*[[Esophageal]] intramural pseudodiverticula   
|
* [[Mucosal]] edema
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion
|
* [[Manometry]] may show dysmotility
* [[CT scan]] for staging [[malignant]] [[strictures]]
|
* [[Esophagogram|Barium esophagogram]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]]
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Non progressive
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Chest pain]]

|Normal
|
* Nonperistaltic and nonpropulsive contractions
* Corkscrew or rosary bead esophagus
|
* Inconclusive
|
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[CT scan]] may show [[hypertrophy]] of esophageal muscles
|
* [[Manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|Non progressive
| +/-
| -
|
* [[Regurgitation]] of undigested food
* [[Chest pain]]
|Normal
|
* "Bird's beak" or "rat tail" appearance 
* Dilated esophageal body
* Air fluid level (absent [[peristalsis]])
* Absence of an intragastric air bubble
|
* Dilated [[esophagus]]
* Residual food fragments 
* Normal [[mucosa]] 
|
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]]
* Increased resting tone of [[Lower esophageal sphincter|LES]]
* Aperistalsis
|
* History of [[dysphagia]] with positive [[endoscopy]] and [[manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|Progressive
| +/-
| +
|
* [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]]

* [[Raynaud's phenomenon]]

* [[Skin changes]] 
|Normal
|
* Dysmotility

* Patulous [[esophagus]]
|
* [[Mucosal]] damage

* [[Peptic]] stricture (advanced cases)
|Positive serology for
* [[Antinuclear antibodies]]

* [[Rheumatoid factor]]

* [[Creatine kinase]]

* [[ESR]]
|
* [[Skin biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]]
|
* Gradual
| +
|<nowiki>-</nowiki>
|
| +/-
| -
|
* Food [[regurgitation]]

* [[Halitosis]]

* [[Coughing|Cough]]

* [[Hoarseness]]
|Normal
|
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
|
* Outpouching of posterior [[pharyngeal]] wall

* Exclude the presence of [[Squamous cell carcinoma|SCC]]
|
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
|
* Barium [[Esophagogram|esophagography]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
|
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
| +
|<nowiki>+/-</nowiki>
|
* [[Lymphadenopathy]]

* [[Cachexia]]
|Normal
|
* Irregular [[Strictures|stricture]]
* Pre-stricture [[dilatation]]
|
* [[Esophageal]] obstruction
* Staging of disease
|
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
|
* [[Biopsy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
([[Cerebral hemorrhage]])
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|
* [[Dysarthria]]

* Limb [[weakness]]

* [[Fatigue]]
|Impaired
|
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]]
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]]
|
* Reduced opening of [[upper esophageal sphincter]]
* Reduced [[larynx]] elevation
|
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]]
|
* [[CT]] without [[Contrast medium|contrast]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
([[Myasthenia gravis]])
|
* Gradual
| +
| +
|Progressive
|<nowiki>+/-</nowiki>
|
|
* [[Ptosis]]
* [[Diplopia]]
* [[Fatigue]]
|Normal
|
* Stasis in [[pharynx]] and pooling in pharyngeal recesses
|
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
|
* CT may show anterior [[mediastinal]] mass ([[thymoma]]) 
* Positive tensilon test 
|
* Anti–acetylcholine receptor antibody test
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
|
* Gradual

* Sudden onset
| +
| -
|Progressive
| +/-
| +
|
* [[Cough]]

* [[Hoarseness]]
|Normal
|
* Free acid reflux
* [[Esophagitis]] with scarring
* [[Strictures]]
* [[Barrett's oesophagus]]
|
* [[Erythema]], erosions and [[ulceration]]
* [[Barrett's esophagus]]
|
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
|
* 24 hour [[esophageal]] pH monitoring
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]]
|
* Gradual
| +
| +/-
|Progressive
| -
| +/-
|
* Findings of the underlying cause such as [[iron deficiency anemia]] or [[bullous pemphigoid]]
|Normal
|
* Symmetrical narrowing of the [[esophagus]]
|
* Smooth membrane not encircling the whole [[Lumen (anatomy)|lumen]]
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
|
* Barium [[esophagogram]]
|-
|[[Eosinophilic esophagitis]]
|Gradual
| +
|
|Progressive
| +/-
| +/-
|
* [[Chest pain]]
* Food impaction
* [[Cough]]
|Normal
|
|
|
|
|}

==References==
{{Reflist|2}}


{{Gastroenterology}}

[[Category:Gastroenterology]]

{{WH}}
{{WikiDoc Sources}}
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