Eosinophilic oesophagitis

Symptoms

The most common symptoms are:

• dysphagia
• food impaction
• thoracic pain
• heartburn (pyrosis)

If the inflammation of the oesophagus and related symptoms are left untreated, they will continue from childhood to adulthood. This inflammation causes structural changes to the oesophagus by remodelling the tissue. This can lead to fibrosis and oesophageal stricture. This means functional deterioration that significantly affects the patient’s quality of life.

Who is affected by eosinophilic oesophagitis?

From the first recorded case in 1993, eosinophilic oesophagitis has been found to affect 45 out of every 100,000 people, and has an incidence rate of 3.7 cases for every 100,000 people a year. This makes it the most common cause of dysphagia, spontaneous oesophageal perforation and food impaction in young patients.

Diagnosis

For appropriate diagnosis, a gastroscopy must be carried out to take multiple biopsies from the oesophagus, since inflammatory alterations can be distributed unevenly. This technique also allows the response to treatment to be assessed. 

Endoscopic analysis of the oesophageal mucous membranes is not sufficient to reach a firm diagnosis, as 10-15% of patients will have normal results of a endoscopy.

Typical treatment

Treatment for EoE is based on three alternative therapies:

• Pharmacological therapy (proton pump inhibitors and topical corticosteroids)
• Dietary treatment with evidence-based diets that eliminate the foods most frequently involved in EoE.
• Endoscopy therapy to urgently treat any bouts of food impaction or to treat oesophageal stricture (oesophageal dilatation). 

Prevention

Early diagnosis is important to prevent complications arising from EoE. Early treatment and clinical and endoscopic monitoring is also essential.