Esophagitis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Esophagitis}} | {{Esophagitis}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Ajay}} | ||
==Overview== | ==Overview== | ||
A complete blood count (CBC) is performed in patients with neutropenia or who are immunosuppressed. | 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 [[CD4|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. | A [[collagen]] workup (eg, [[antinuclear antibody]] [ANA], [[Anti-dsDNA antibody|anti-dsDNA]]) may be performed based on the underlying disease. | ||
==Laboratory Findings== | |||
===Eosinophilic Esophagitis=== | |||
Laboratory findings of the EoE are as follows:<ref name="pmid18304887">{{cite journal |vauthors=Roy-Ghanta S, Larosa DF, Katzka DA |title=Atopic characteristics of adult patients with eosinophilic esophagitis |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=5 |pages=531–5 |year=2008 |pmid=18304887 |doi=10.1016/j.cgh.2007.12.045 |url=}}</ref><ref name="pmid20568382">{{cite journal |vauthors=Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA |title=Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis |journal=Ann. Allergy Asthma Immunol. |volume=104 |issue=6 |pages=496–502 |year=2010 |pmid=20568382 |doi=10.1016/j.anai.2010.03.018 |url=}}</ref><ref name="pmid19733260">{{cite journal |vauthors=Dellon ES, Gibbs WB, Fritchie KJ, Rubinas TC, Wilson LA, Woosley JT, Shaheen NJ |title=Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=12 |pages=1305–13; quiz 1261 |year=2009 |pmid=19733260 |doi=10.1016/j.cgh.2009.08.030 |url=}}</ref><ref name="pmid18061100">{{cite journal |vauthors=Chehade M, Sampson HA |title=Epidemiology and etiology of eosinophilic esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=18 |issue=1 |pages=33–44; viii |year=2008 |pmid=18061100 |doi=10.1016/j.giec.2007.09.002 |url=}}</ref><ref name="pmid17617209">{{cite journal |vauthors=Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ |title=Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2300–13 |year=2007 |pmid=17617209 |doi=10.1111/j.1572-0241.2007.01396.x |url=}}</ref><ref name="pmid17426462">{{cite journal |vauthors=Aceves SS, Newbury RO, Dohil R, Schwimmer J, Bastian JF |title=Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder |journal=J. Clin. Gastroenterol. |volume=41 |issue=3 |pages=252–6 |year=2007 |pmid=17426462 |doi=10.1097/01.mcg.0000212639.52359.f1 |url=}}</ref> | |||
*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: | |||
{| class="wikitable" | |||
!Test | |||
!Procedure | |||
!Interpretation | |||
|- | |||
|'''Skin prick testing''' | |||
|A small amount of [[allergen]] is introduced into the [[skin]] of the patient through a gentle [[Puncture wound|puncture]] with a pricking device. | |||
| | |||
* Causes [[Hypersensitivity reactions|type-1 hypersensitivity reaction]] | |||
* An area of [[Erythema|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 [[Esophagus|the esophagus]].<ref name="pmid23419381">{{cite journal| author=Katz PO, Gerson LB, Vela MF| title=Guidelines for the diagnosis and management of gastroesophageal reflux disease. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 3 | pages= 308-28; quiz 329 | pmid=23419381 | doi=10.1038/ajg.2012.444 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23419381 }}</ref> | |||
* Indications of ambulatory reflux monitoring include the following:<ref name="pmid234193812">{{cite journal| author=Katz PO, Gerson LB, Vela MF| title=Guidelines for the diagnosis and management of gastroesophageal reflux disease. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 3 | pages= 308-28; quiz 329 | pmid=23419381 | doi=10.1038/ajg.2012.444 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23419381 }}</ref> | |||
** [[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 unit|Telemetry]] capsule (48 hours monitoring) | |||
** Transnasal catheter (24 hours monitoring) | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
Latest revision as of 21:41, 29 July 2020
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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. |
|
| Atopy patch testing |
|
|
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]
- Ambulatory reflux monitoring is performed in either two ways which include:
- Telemetry capsule (48 hours monitoring)
- Transnasal catheter (24 hours monitoring)
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.