Sometimes, what appears to be a clear case of gastroesophageal reflux disease (GERD) is something else: eosinophilic esophagitis (also known as EoE or EE). This disease often has symptoms that are identical to GERD, but it is actually triggered when an allergic response — typically to a food — causes eosinophils to proliferate in the esophagus, inflaming the tissue.1 Below, Jonathan Markowitz, MD, director of Pediatric Gastroenterology at Greenville Children’s Hospital in South Carolina, talks about how to diagnose and treat EoE.

What is eosinophilic esophagitis, and how does it relate to GERD?
The symptoms of EoE, which can include regurgitation, difficulty swallowing, a burning sensation, nausea, and vomiting, can be very difficult to distinguish from GERD. Many people who are suffering from EoE are initially told that they have reflux disease. The difference is that patients with EoE won’t respond to traditional GERD treatments, and their health providers may want to consider EoE as an alternative diagnosis.

Research is finding that EoE is much more common than we thought it was in the past, so if a physician sees a patient who is not responding to GERD treatment, he or she should consider EoE. Physicians should also keep in mind that while EoE is sometimes thought of as a pediatric condition, it occurs frequently in adult patients.

How is eosinophilic esophagitis typically diagnosed?
In order to diagnose EoE, a patient must have a positive biopsy, which shows that eosinophils are present in the esophagus above a certain density, and also the traditional symptoms of the disease. Keep in mind that a positive biopsy alone is not enough to diagnose EoE.

Physicians should also be aware of another condition called PPI-responsive esophageal eosinophilia, which mimics EoE in both biopsy findings and symptoms, but, unlike traditional EoE, can be treated with proton pump inhibitors. If a patient meets the criteria for EoE, but the symptoms and findings go away after treatment with a PPI, EoE is not necessarily the correct diagnosis.