Eosinophilic oesophagitis

Eosinophilic oesophagitis (EoO) is a chronic immune-mediated/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and pathologically by an eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes of local or systemic eosinophilia.

To consider the diagnosis, there must be an oesophageal epithelial infiltrate of ≥15 eosinophils per high-power microscopy field on oesophageal biopsy.

Incidence and prevalence are increasing at a rate that is outpacing increased recognition and diagnosis; it is more commonly seen in children and young adults.

Medications (usually topical/swallowed corticosteroids or proton-pump inhibitors) or dietary elimination can be used as a first-line treatment, with endoscopic dilation reserved for patients with oesophageal strictures or fibrostenotic complications.

Prognosis is good, with the majority of patients having a good response to either pharmacological or dietary elimination therapy.

Eosinophilic oesophagitis (EoO) is a chronic, immune-mediated/allergen-mediated clinicopathological condition. It is characterised clinically by symptoms of oesophageal dysfunction (e.g., dysphagia and food impaction in adolescents and adults, and vomiting, regurgitation, heartburn, abdominal pain, failure to thrive, or feeding intolerance in children), and histologically by an eosinophilic infiltration of the oesophageal epithelium of ≥15 eosinophils per high-power microscopy field in the absence of other causes of local or systemic eosinophilia.[1]Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul;128(1):3-20. http://www.jacionline.org/article/S0091-6749(11)00373-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21477849?tool=bestpractice.com ​​[2]Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007 Oct;133(4):1342-63. http://www.gastrojournal.org/article/S0016-5085(07)01474-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/17919504?tool=bestpractice.com ​​[3]Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013 May;108(5):679-92. http://www.ncbi.nlm.nih.gov/pubmed/23567357?tool=bestpractice.com [4]Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459-87. https://gut.bmj.com/content/71/8/1459 http://www.ncbi.nlm.nih.gov/pubmed/35606089?tool=bestpractice.com ​ To account for the increasing use of digital optical microscopy, the joint consensus guidelines from the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition recommend using an updated peak eosinophil count of ≥15 per 0.3 mm².[4]Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459-87. https://gut.bmj.com/content/71/8/1459 http://www.ncbi.nlm.nih.gov/pubmed/35606089?tool=bestpractice.com ​​​​ The condition is also abbreviated to EoE.