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
Diagnostic criteria
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