Differential Diagnosis for Eosinophilic Esophagitis vs. GERD
Single Most Likely Diagnosis
- Eosinophilic esophagitis: This condition is characterized by a high concentration of eosinophils in the esophageal mucosa, often presenting with symptoms of dysphagia, food impaction, and heartburn that is refractory to standard acid suppression therapy. Clinical differentiation from GERD can be challenging without endoscopy or histology, but the presence of atypical symptoms such as dysphagia to solid foods or a history of atopic diseases (e.g., asthma, eczema) may suggest eosinophilic esophagitis.
Other Likely Diagnoses
- GERD (Gastroesophageal Reflux Disease): Presents with typical symptoms of heartburn and regurgitation, which can sometimes overlap with those of eosinophilic esophagitis. However, GERD symptoms often improve with acid suppression therapy, and the absence of such improvement might raise suspicion for eosinophilic esophagitis.
- Functional dysphagia: A condition characterized by difficulty swallowing without an apparent mechanical obstruction. It can mimic the dysphagia seen in eosinophilic esophagitis but typically lacks the inflammatory component.
Do Not Miss Diagnoses
- Esophageal cancer: Although rare, esophageal cancer can present with progressive dysphagia and should always be considered in the differential diagnosis of dysphagia, especially in older adults or those with risk factors such as smoking or a history of Barrett's esophagus.
- Achalasia: A motility disorder of the esophagus characterized by the inability of food to pass into the stomach, leading to dysphagia. It is less common than GERD or eosinophilic esophagitis but is critical to diagnose due to its significant impact on quality of life and potential for complications.
Rare Diagnoses
- Eosinophilic gastroenteritis: A rare condition involving eosinophilic infiltration of the gastrointestinal tract, which can present with a variety of symptoms including dysphagia, abdominal pain, and gastrointestinal bleeding.
- Chagas disease: Caused by Trypanosoma cruzi, this parasitic infection can lead to esophageal dysfunction and dysphagia in its chronic phase, particularly in individuals from endemic areas of Latin America.