eosinophilic oesophagitis (EoE)

Introduction

EoE is perhaps the second most common oesophageal condition after gastro-oesophageal reflux
it is a non-IgE-mediated condition caused by various food allergies resulting in chronic oesophagitis and histologic changes dominated with eosinophils
it occurs more frequently in those who have asthma or hay fever and thus is often familial

dysphagia to solids is a common presentation and this may result in food bolus impaction
symptoms can be similar to GOR however, symptoms tend to occur while eating whereas symptoms of GOR usually occur some hours after eating such as during the night

via histology at gastroscopy showing an eosinophil count over 15 per high-power field
NB. if high levels of eosiniphils are also found on small bowel or stomach biopsies then it is generally regarded to be eosinophilic gastrointestinal disease rather than EoE
NB> does not usually cause eosinophilia in the blood stream

proton pump inhibitors (PPIs) - appear to act not via acid lowering but by anti-inflammatory properties
identify and exclude the food allergen (life long exclusion) if possible
- the two most common causes for EoE are dairy-based or animal milk protein-based products, or wheat
- less common food antigens are eggs, soy, nuts and seafood
oral budesonide
- tablet is placed on the tip of the tongue, and then a patient leaves it in their mouth for about 20 to 30 minutes, and allows it to slowly dissolve, and that coats the oesophagus
- risk of candidiasis so may need concurrent prophylaxis or Rx for this