Number of Eosinophilic Cells/Allergy Versus GERD

Dr Pho:

One last followup question. You answered a number of questions for me so far. I am the 29 male that had sudden onset of solid food dysphagia at the end of April, and I have gone for CT Scan (clear), Barium Swallow (Modified and Regular), and an endoscopy. CT Scan revealed mild sinus disease. The endoscopy showed no acid related damage i.e. erosions or inflammation. However, the biopsy showed an infiltration of Eosinophilic cells, but 5 or less per high power view which is consistent with acid reflux. However, I never had any symptoms of reflux and the endoscopy showed no reflux damage. I was put on a PPI at the beginning of May just in case it was reflux. I have continued on that. This week will be my fifth week.


My question is there a strict cutoff in terms of number of Eosinophilic cells that may be caused allergic esophagitis versus GERD? My symptoms have not responded to acid reducing medications, and I have a history of allergy issues. I would hate to continue to suffer and taking PPI's for no reason if the cause is allergy of some type. I am assuming it would be aero in nature since I have been eating the same foods for years..

[Kevin Pho, MD]

There is no consensus as to the diagnosis of eosinophilic esophagitis.  The best way to exclude this would be biopsies of the esophagus and stomach.  

Normally, 20 eosinophils per high power field is present in cases of this uncommon disease.  5 or less, as in your case, can still be caused by other conditions.  

A 24-hr pH study can be considered to further quantify any reflux.

These options can be discussed with your GI physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_