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
- Skin prick testing
- 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.
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
- ↑ 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.