- Chronic inflammatory, allergic disorder of the esophagus
- Triggered by food – commonly milk, wheat, soy, eggs, seafood
- 1 in 100 adults
- 1 in 10,000 children
- history of other atopic conditions
- eg asthma, allergic rhinitis or atopic dermatitis
- more common in males,
- Usually present < 40 years
- Clinical
- difficulty swallowing or food impaction
- Dysphagia, heart burn
- Stricture lumen
- Food bolus obstruction
- Minimal improvement with acid suppression
- Children
- difficulty feeding
- failure to thrive
- vomiting
- EoE is accompanied by a diffuse loss of oesophageal compliance. In critical disease, patients present with food bolus impaction as a result of a narrow-calibre oesophagus and dysmotility.
- advanced forms of the disease are at risk of spontaneous oesophageal perforation (Boerhaave’s syndrome) and perforation during endoscopy
- symptoms related to oesophageal dysfunction
- ≥15 eosinophils/hpf on oesophageal biopsy
- persistence of eosinophilia after a proton pump inhibitor trial
- secondary causes of oesophageal eosinophilia excluded.
- Other causes of oesophageal eosinophillia
- GORD – Food impaction rare, NO ATOPY FEATURES
- Achalsia
- Crohn’s
- Parasitic infection
- Drug hypersensitivity
- Scleroderma
- Coeliac
- Hyper-eosinophillic syndromE
- Treatment
- Treatment involves avoiding trigger foods and corticosteroid therapy
- Dietary
- Targeted elimination of common causes
- Allergy testing typically involves skin prick or patch tests of a wide variety of foods.
- Although this approach is often preferred by patients, the success rate is <50
- Six food elimination diet – avoidance of the six food types that are most commonly associated with allergy.
- MilK
- Wheat
- Eggs
- Soy
- Nuts
- seafood.
- achieved histological remission in approximately 72% of patients
- The elemental diet
- food intake with a liquid formula composed of amino acids, carbohydrates, fats and minerals.
- success rate of elemental diets is in the order of 90%
- rarely tolerated by patients
- Barriers include high cost, unpleasant taste and the need to forgo all food, with the social limitations that entails.
- Topical glucocorticoids
- Swallow solutions that are normally for inhalation 🡪 coat the esophagus
- Fluticasone MDI – swallow with water Or budesonide liquid
- No oral intake 30 minutes following
- Endoscopic Dilation strictures
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