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.

An autoimmune disorder, coeliac disease is the genetically predisposed reaction to ingesting gluten; a protein found in wheat, rye, barley, oats, spelt, kamut, and triticale.

For coeliacs, ingesting gluten damages the villi in the small intestine, affecting their capacity to absorb nutrients from food (proteins, carbohydrates, fats, vitamins and minerals).

People of any age may have the condition, and although people from any part of the world may be affected, it appears to be most common among white people whose ancestors were from Northern Europe. The most recent studies show the disease affects around 1 person in 100, and it is currently considered the most common chronic intestinal disorder in the western world.

Symptoms

Although some coeliacs may not show any symptoms, the most common are:

• Gastrointestinal symptoms: diarrhoea, malnutrition and weight loss
• Non-gastrointestinal symptoms: dermatitis herpetiformis

Who is affected by coeliac disease?

It is not fully understood why someone may develop coeliac disease, but several genetic factors are known to make people predisposed to the condition. However, it appears that having a genetic predisposition does not necessarily lead to the disease and that certain environmental factors are required. Despite its genetic origin, we cannot say that it is an inherited disease, although if we look at the general population, the likelihood of someone having the condition is increased if a family member also has it. If there is a family history then the likelihood of having it is 10 %.

First-degree relatives of coeliacs and people with related illnesses such as type 1 diabetes or autoimmune diseases are at greater risk.

Coeliac disease may occur at any age and is more prevalent in women than in men. In Catalonia 1 in every 204 citizens has the condition and it is more common in children than in adults.

Diagnosis

The diagnostic process is based on clinical suspicion or recognising some of the risk factors. Serological markers such as anti-transglutaminase antibodies or deamidated gliadin peptide antibodies are used. If they are positive, an endoscopic intestinal biopsy should be performed to confirm diagnosis.

Genetic testing for HLA-DQ2 and HLA-DQ8 can also be carried out to identify people at risk of developing the disease.

Typical treatment

Treatment for coeliac disease currently consists of completely and permanently eliminating gluten from the patient’s diet.

Coeliacs cannot eat any foods that contain wheat, oats, barley, or rye. In most cases, complete and lasting recovery from the intestinal damage is achieved, provided the patient does not go back to eating foods containing gluten. Avoiding gluten is only recommended for people with coeliac disease or non-coeliac gluten intolerance and is not necessary, nor recommended, for the general population.