Questions to ask your Doctor

Eosinophilic esophagitis is divided into primary or secondary. Primary eosinophilic esophagitis is further subclassified into idiopathic (unknown cause), atopic (allergic) or familial. Secondary eosinophilic esophagitis could be due to a more generalized eosinophilic disorder, such as eosinophilic gastroenteritis or hypereosinophilic syndrome or due to noneosinophilic disorders such as drug reactions, infections, gastroesophageal reflux, connective tissue disorders, vasculitis and leiomyomatosis.

It is important to know if the increased eosinophils were found only in the esophagus, in the stomach, in the duodenum or in all of them. If the esophagus is affected, it is also essential to know if it was the lower part only, the upper part only or both. This information will help in the decision making (Is it eosinophilic esophagitis? Is it gastroesophageal reflux? Is it eosinophilic gastroenteritis?).

More than 15 eosinophils per high power field (in the microscope) in esophageal biopsies are suggestive of primary eosinophilic esophagitis while less than that are associated with food allergies or gastroesophageal reflux.

A good percentage of patients with eosinophilic disorders of the gastrointestinal tract have food allergies. This area needs to be thoroughly evaluated by a doctor who is specialized in allergy and immunology.

Many disorders are associated with increased numbers in eosinophils in the gut. A complete history and physical exam plus associated tests should narrow the diagnosis.

 

Source Cincinnati Center for Eosinophilic Disorders, Cincinnati Children’s Hospital Medical Center