Eosinophilic oesophagitis

Eosinophilic oesophagitis is a chronic disease of immune origin (i.e. due to the production of antibodies in the body), which is characterised clinically by symptoms of oesophageal dysfunction with the main symptom being difficulty in swallowing, and histologically by an increase in the number of eosinophilic cells in the oesophageal mucosa. Its aetiology is unknown, but it is thought to be caused by food allergies and occurs most frequently in young and middle-aged men.

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Diagnosis

The diagnosis of eosinophilic oesophagitis requires clinical suspicion and gastroscopy and biopsies of the oesophagus. Gastroscopy very often reveals macroscopic lesions on the mucosa of the oesophagus but in many cases the diagnosis can only be made by analysis of the biopsies. Biopsies reveal a high number of eosinophils (>15 COP). Eosinophils in oesophageal biopsies may also be found in other cases but not in such high numbers. The differential diagnosis of eosinophilic oesophagitis includes oesophageal reflux disease, oesophageal eosinophilia responsive to proton-proton inhibitors (PPIs), Crohn's disease, vasculitis or other connective tissue diseases as well as drug hypersensitivity and graft versus host disease.

Symptoms of osinophilic esophagitis?

The main symptom of eosinophilic oesophagitis is dysphagia in which the patient has difficulty swallowing food as it passes through the oesophagus and often has episodes of intussusception after meals. The patient may experience back pain, reflux of food or vomiting. When the disease occurs at an early age the patient may experience growth retardation, refusal to eat and recurrent episodes of vomiting.

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Treatment

Treatment usually involves changes in diet and medication. In the first instance, other disorders associated with eosinophilic esophageal infiltration should be excluded. Initially the patient is treated with PPIs and gastroscopy is repeated with biopsies to exclude eosinophilia responsive to PPIs. Subsequently, and if oesophageal eosinophilia persists, tests may be required to detect possible food allergies.

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An important role in the treatment of the disease is the modification of the diet and the implementation of a specific diet (SFED) which has been associated with excellent results in the treatment of the disease. After the symptoms improve, you may be able to reintroduce some of the foods that you have excluded from your diet because of eosinophilic oesophagitis.

In diet-resistant cases or to relieve symptoms, cortisone may be used in the form of inhaled or dispersed tablets. Corticosteroids help reduce inflammation by attaching to immune cell receptors and reducing the release of substances involved in the inflammation building process. In recent years, biological agents have also been used to treat the disease.

Finally, endoscopy plays an important role in the treatment of complications of the disease such as in cases of narrowing of the esophageal lumen. In these cases, the stenoses are dilated using a balloon to facilitate swallowing and avoid episodes of dysphagia and pyloric intussusception.