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Two esophagus conditions stump doctors, despite different treatment methods

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Two on-the-rise esophagus conditions are so similar that even a biopsy cannot easily distinguish one from the other, yet they are very different in terms of what treats them.

Researchers published a study on the two in the American Journal of Gastoenterology.

Distinguishing treatments

The study, lead by Evan Dellon, M.D., MPH, and associate professor or medicine and epidemiology at UNC, found that eosinophilic esophagitis (EoE) and PPI-responsive esophageal eosinophilia (PPI-REE) are extremely similar in both symptomology and cause, but treatments are very different.

Both can be caused by a food allergy, and biopsies for either will show high counts of a specific white blood cell. With similar symptoms, it is very difficult – often impossible – to distinguish EoE from PPI-REE. Doctors often distinguish them by treatment method, testing one treatment and then the other.

Testing with PPI medication

Normally, patients are pre-diagnosed with PPI-REE and treated with antacid medications (or PPI inhibitors) and then re-tested for another white blood count, requiring a second painful endoscopy. A high count will then result in a diagnosis for EoE and the ending of PPI inhibitors and the introduction of anti-inflammatory medication, usually a steroid typically prescribed for 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.

Unfortunately, Dellon's study did not find an alternative way to diagnose either illness. They are working on a new vein, however, utilizing a special stain that may predict if biopsied cells will respond to antacids, indicating PPI-REE.

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