Esophagitis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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
Skin prick testing
- A small amount of allergen is introduced into the skin of the patient through a gentle puncture with a pricking device.
- Patients who are sensitive to the allergen have immunoglobulin E (IgE), which causes type-1 hypersensitivity reaction and cause an area of redness and swelling around the prick.
- The entire procedure takes 15 min, however, these tests may have limited use in identifying foods causing or precipitating EoE.
Blood allergy testing
- Serum specific immune assay can be done for the allergen testing especially in patients with food allergies.
- Although there are many limitations for the prick testing and the blood testing for the allergy in patients with EoE, prick testing is considered more efficient in EoE.
Atopy patch testing
- Atopy patch testing is another way of identifying the allergies in patients with EoE.
- This is more useful in the pediatric population than in the adults.
- Patch testing is used to identify patients with delayed reactions to a food.
- Procedure: 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.
- A positive delayed reaction to the food is determined by the inflamed area of the skin around the Finn chamber.
- The results from the food patch test helps the physician to determine which foods can be avoided
- All the above-mentioned tests can have false positive tests, it is also possible to have a false negative test, meaning that the prick, blood or patch tests are negative yet the allergen can contribute towards a patient’s EoE.
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
- ↑ 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.