Biopsies may overlook esophagus disease

University of Utah engineers mapped white blood cells called eonsinophils and showed an existing diagnostic method may overlook an elusive digestive disorder that causes swelling in the esophagus and painful swallowing.

By pinpointing the location and density of eosinophils, which regulate allergy mechanisms in the immune system, these researchers suggest the disease eosinophilic esophagitis, or EoE, may be under- or misdiagnosed in patients using the current method, which is to take tissue samples (biopsies) with an endoscope.

These findings are published as the cover article in the September 2012 issue of the Journal of Allergy and Clinical Immunology. Despite the limitations of current detection methods for EoE, the study authors say biopsies remain the current standard of care, but the engineers are working toward new diagnostic methods that could be available in five years.

In EoE, eosinophils typically found in the bloodstream invade the esophagus and start chewing away at its lining. Often triggered by food allergies, EoE symptoms overlap with other disorders such as acid reflux.

"The gold standard for understanding this disease is detecting the location and presence of eosinophils in the esophagus. Unfortunately, eosinophils are not uniformly distributed within the esophagus, which can lead to underdiagnosis," says study co-author Leonard Pease, assistant professor of chemical engineering at the University of Utah. He is also an adjunct professor of gastroenterology and pharmaceutics.

The University of Utah team showed that even a patient with known EoE would require more than 31 random tissue samples, or biopsies, from an area in the esophagus with low eosinophil density to reliably diagnose EoE. Currently, if a patient is suspected of having EoE, five to 12 biopsies are collected along the esophagus using an endoscope. If more than 15 eosinophils turn up in any one of these samples, a diagnosis of EoE is made.

Painful swallowing Email this page to a friend Share on facebook Share on twitter Bookmark & Share Printer-friendly version

Swallowing pain is any pain while swallowing. You may feel it high in the neck or lower down behind the breastbone. It is most often a strong feeling of uncomfortable squeezing and burning. Swallowing pain may be a symptom of a serious disorder.

Considerations

Swallowing is a complex act that involves the mouth, throat area, and esophagus (the tube that moves food to the stomach). Many nerves and muscles control how these body parts work. Part of swallowing is voluntary, which means you are aware of controlling the action. However, much of swallowing is involuntary.

Problems at any point - from chewing food and moving it into the back of the mouth to moving the food into the stomach - can result in painful swallowing.