Spurred by food allergies, two esophagus conditions stump doctors

December 16, 2013

Researchers at the UNC School of Medicine found that two on-the-rise esophagus conditions are so similar that even a biopsy is not enough to distinguish one disease from the other.

One condition is called eosinophilic esophagitis, or EoE. The other is PPI-responsive esophageal eosinophilia, or PPI-REE. Symptoms for each condition include difficulty swallowing, persistent heartburn, and getting food stuck in the throat. Both are diagnosed with an endoscopy, which reveals high numbers of a certain type of white blood cell – an eosinophil – in biopsies of both conditions. But finding a lot of white blood cells does not distinguish EoE from PPI-REE, said Evan Dellon, MD, MPH, associate professor of medicine and epidemiology and lead author of a study published in the American Journal of Gastroenterology.

Dellon says that both conditions can be the result of a food allergy, but they require different treatments.

Patients whose white can be lowered by antacid medications, also called proton-pump inhibitor (PPI) medications, are diagnosed with PPI-REE. However, finding out if the white blood cell count was lowered requires a second endoscopy and biopsy. If the count remained high, then are diagnosed with EoE and require an anti-inflammatory medication, such as a steroid typically used to treat asthma.

"Unfortunately, right now the only way to differentiate between the conditions is to do the PPI medication trial and then repeat the endoscopy," Dellon said.

During his study, Dellon's team wanted to see if any symptoms, endoscopic views of the esophagus, or tissue samples could help him differentiate the two conditions so that future patients wouldn't have to go through an eight-week antacid trial and a second endoscopic biopsy, an invasive procedure that is safe but costly and requires sedation.

The study enrolled 223 patients with esophageal complaints. Dellon's team took small samples of tissue from the patients and examined them for the presence of eosinophils—. Patients with a high eosinophil count were given an 8-week course of antacids. The study showed that approximately 30 to 40 percent of the participants responded to the antacid medication. They were diagnosed with PPI-REE.

Patients who did not respond to antacids were diagnosed with EoE. There are no FDA-approved medicines for EoE, so the steroids that doctors prescribe are considered off-label use. There are, however, several randomized, double-blind studies that show that these medications work for EoE.

"The other option for treating EoE is to try a variety of elimination diets to remove the most common food triggers, such as wheat, dairy, soy, or eggs," Dellon said. "We know that it's mostly an allergic reaction because if you take away all allergens, nearly everyone will get better very quickly. But that isn't a practical treatment for many people."

After rigorous analysis, Dellon and his colleagues did not find any clinical or endoscopic characteristics that could reliably distinguish the two conditions. This means patients will still need to undergo the PPI trial and repeat endoscopy in order to be properly diagnosed.

Dellon's team is working on an extension of this study that uses a special stain on the cell biopsies that he hopes will predict who will respond to antacids. Dellon also wants to investigate patient genetics as a possible diagnostic tool.

"This whole antacid response and even the existence of PPI-REE as a condition weren't really described well until two years ago," Dellon said. "So the diagnostics are still very much in flux right now."

Explore further: Researchers develop first molecular test to diagnose eosinophilic esophagitis

More information: www.nature.com/ajg/journal/v10 … ull/ajg2013363a.html

Related Stories

Researchers develop first molecular test to diagnose eosinophilic esophagitis

November 21, 2013
Researchers at Cincinnati Children's Hospital Medical Center have developed the first molecular test to diagnose eosinophilic esophagitis (EoE), a chronic upper gastrointestinal disorder. The incidence of EoE has skyrocketed ...

Food elimination diet identifies causes of difficulty swallowing and swelling of the throat

June 20, 2012
A six-food elimination diet significantly improves symptoms in adult patients with eosinophilic esophagitis (EoE), according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association. ...

Genetic marker for painful food allergy points to improved diagnosis, treatment

March 9, 2012
Researchers have identified a genetic signature for a severe, often painful food allergy – eosinophilic esophagitis – that could lead to improved diagnosis and treatment for children unable to eat a wide variety ...

A bad alliance: Rare immune cells promote food-induced allergic inflammation in the esophagus

July 21, 2013
Food is an integral part of life; but, for some, it can be harmful. Allergic inflammation caused by inappropriate immune responses to some types of food has become a major public health issue. Over the past ten years, the ...

Elimination diet can treat eosinophilic esophagitis in adults

June 8, 2012
(HealthDay) -- A six-food elimination diet can successfully treat adults with eosinophilic esophagitis (EoE), according to a study published in the June issue of Gastroenterology.

Recommended for you

Novel approach to track HIV infection

August 18, 2017
Northwestern Medicine scientists have developed a novel method of tracking HIV infection, allowing the behavior of individual virions—infectious particles—to be connected to infectivity.

Faulty gene linked to obesity in adults

August 18, 2017
Groundbreaking new research linking obesity and metabolic dysfunction to a problem in the energy generators in cells has been published by researchers from the Harry Perkins Institute of Medical Research and The University ...

Two lung diseases killed 3.6 million in 2015: study

August 17, 2017
The two most common chronic lung diseases claimed 3.6 million lives worldwide in 2015, according to a tally published Thursday in The Lancet Respiratory Medicine.

New test differentiates between Lyme disease, similar illness

August 16, 2017
Lyme disease is the most commonly reported vector-borne illness in the United States. But it can be confused with similar conditions, including Southern Tick-Associated Rash Illness. A team of researchers led by Colorado ...

Addressing superbug resistance with phage therapy

August 16, 2017
International research involving a Monash biologist shows that bacteriophage therapy – a process whereby bacterial viruses attack and destroy specific strains of bacteria - can be used successfully to treat systemic, multidrug ...

Can previous exposure to west Nile alter the course of Zika?

August 15, 2017
West Nile virus is no stranger to the U.S.-Mexico border; thousands of people in the region have contracted the mosquito-borne virus in the past. But could this previous exposure affect how intensely Zika sickens someone ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.