CHAPEL HILL, N.C. 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 blood cell count 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 patients 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. Dell
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University of North Carolina Health Care