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  INCLUSION CRITERIA:

  In order to be eligible to participate in this study, an individual must meet all of the following criteria: 1.

Able to provide informed consent. 2. Aged 18 to 65 years. 3. Born in the African continent and of African ancestry. 4. Exhibiting symptoms of dysphagia and/or prior history of food impaction. 5. Undergoing clinically indicated endoscopy at the NIH Clinical Center or Centre Hospitalier Universitaire Gabriel Toure and willing to provide research samples and data.

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study: 1. Recent steroid use (systemic or swallowed/topical corticosteroid) within 4 weeks prior to endoscopy. 2. Recent use of dupilumab (Dupixent) within the last 6 months. 3. Recent use of other biologic medications (within either 6 months or 5 half-lives, whichever is longer). Examples of biologic medications include: 3a. mepolizumab (Nucala) 3b. reslizumab (Cinqair, Cinqaero) 3c. benralizumab (Fasenra) 3d. cendakimab.3e. tezepelumab (Tezspire) 3f. barzolvolimab. 4. Individuals suffering from a bleeding diathesis (e.g., hemophilia, severe thrombocytopenia). 5. Current use of anticoagulant medications. 6. Pregnancy. 7. Treatment with another investigational drug or other investigational intervention within 6 months or 5 half-lives whichever is longer. 8. Individuals with a known history of any of the following: 8a. eosinophilic esophagitis.8b. esophageal stricture unable to be passed with an upper endoscope.8c. esophageal cancer.8d. esophageal motility disorder (e.g., achalasia) 8e. esophageal varices.8f. esophageal or gastric surgery including fundoplication.8g. neurologic cause of dysphagia (e.g., stroke, Parkinson s disease, etc.) 8h. allergy to gelatin.8i. inability to swallow pills. 9. Any condition that, in the investigator s opinion, places the individual at undue risk by participating in the study. Co-enrollment guidelines: Co-enrollment in other trials is restricted, other than enrollment on observational studies. Consideration for co-enrollment in trials evaluating the use of a licensed medication will require the approval of the principal investigator in consultation with the medical monitor. Study staff should be notified of co-enrollment on any other protocol as it may require the approval of the principal investigator.

Study Description: Eligible participants will be enrolled to assess the performance and accuracy of the 1-hour esophageal string test (EST) as a diagnostic screening tool for eosinophilic esophagitis (EoE). Consenting participants in the U.S. (n=30) and Mali (n=30) undergoing clinically indicated esophagogastroduodenoscopy (EGD) will have an EST performed prior to the procedure. Clinical data, including medical history and laboratory test results, will be captured on a case report form. Symptoms will also be assessed using validated patient reporting outcome measures: the Brief Esophageal Dysphagia Questionnaire (BEDQ) and Patient-Reported Outcomes Measurement Information System (PROMIS-GI and -57). Dietary, sociodemographic, and environmental histories will be obtained by validated questionnaires. Blood, urine, stool, and skin swab/tape strip samples will be obtained for additional biomarker studies. Participants will be screened for intestinal helminth infections by stool polymerase chain reaction (PCR). Tissue samples obtained during EGD will be assessed for Helicobacter pylori by histopathology. Esophageal biopsy samples and remaining EST eluents will be allocated for investigational studies. Air and water samples will be collected from areas within the participants community and analyzed to determine potential correlation with elevated levels of environmental pollutants. The hypothesis of this study is that the 1-hour EST will provide a preliminary estimate of EoE prevalence among Africans and African immigrants presenting with dysphagia. Primary Objective: -Assess the accuracy of the 1-hour EST as a diagnostic screening tool for EoE among African-born individuals presenting with dysphagia in the U.S. and Mali. Secondary Objective: -Determine the frequency of EoE among African-born individuals presenting with dysphagia in the U.S. and Mali. Primary Endpoint(s):

• - Sensitivity, as estimated by the proportion of positive EST-obtained EoE-Score(TM) results out of those diagnosed with EoE by the gold standard of esophageal biopsy.

• - Specificity, as estimated by the proportion of negative EST-obtained EoE-Score(TM) results out of those diagnosed with EoE by the gold standard of esophageal biopsy.

Secondary Endpoints: -Proportion of EoE cases diagnosed in each cohort.

Arms

Experimental: Esophageal string test

The esophageal string test is a minimally invasive procedure used to collect esophageal secretions for diagnostic analysis.

Interventions

Device: - Esophageal string test

The esophageal string test consists of a gelatin or cellulose capsule containing a nylon string. The capsule dissolves allowing the nylon string to absorb esophageal secretions which can be analyzed for various inflammatory mediators.