March 14th, 2014
Dysphagia and Normal Endoscopy – Should We Biopsy Everyone?
The “discovery” of eosinophilic esophagitis (EoE) has added immensely to our understanding of many patients with dysphagia, and when endoscopic signs are present (furrowing, rings, white nodules, etc.), we should always confirm the diagnosis with endoscopic biopsies. However, many patients with EoE have a normal-appearing esophageal mucosa, and EoE would remain undetected if biopsies were not obtained. This concept has led many endoscopists to now routinely obtain endoscopic esophageal biopsies in all patients with dysphagia. I admit that this has become my predominant practice as well.
What are you doing in your practices?
More specifically …
- Do you routinely biopsy the esophagus in patients with dysphagia and an esophagus that appears normal?
- If yes, where do you biopsy, how many biopsies do you take, and how often are findings positive in these patients?
- If no, do you perform any other diagnostic tests in these patients with a normal-appearing esophagus (e.g., barium pill swallows, esophageal motility studies, etc.)?