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Review
Eosinophilic oesophagitis: recent advances and practical management
  1. Stephen Attwood1,
  2. Jenny Epstein2
  1. 1Health Services Research, Durham University, Durham, UK
  2. 2Paediatric Gastroenterology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Jenny Epstein, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK; jenny.epstein{at}chelwest.nhs.uk

Abstract

Eosinophilic oesophagitis (EoE) is a disease identified just over 30 years ago. The main symptom is dysphagia. EoE is initially inflammatory and progresses to fibrosis. There are differences in clinical presentation between young children and adults. Diagnosis is by endoscopy and six biopsies at varying positions of the oesophageal lining. Blood tests are of no diagnostic value as the condition is mediated by IgG4 local mucosal pathology. Endoscopic signs are distinct from those of gastro-oesophageal reflux. Histological signs of EoE are >15 eosinophils/high-power field on a background of hyperplastic mucosa. Options of therapy include diet restriction, proton pump inhibitors therapy and topical steroids but there is a dearth of randomised control trials to define the optimum approach. The only licenced therapy for EoE is budesonide orodispersible tablet, a specific formulation for oesophageal topical steroid therapy. EoE is the most common cause of spontaneous perforation in the oesophagus. Stricture formation occurs in up to 10% and may require therapeutic dilatation.

  • dysphagia
  • oesophageal disease
  • oesophagitis
  • paediatric gastroenterology
  • oesophageal strictures
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Footnotes

  • Contributors Both authors contributed directly to the development, writing and editing of this review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SA is a paid speaker for the following companies related to the treatment of oesophageal diseases, Dr Falk Pharma, Medtronic Inc and research advisor to Dr Falk Pharma, AstraZeneca and EsoCap Inc. JE is a paid speaker and advisor to Dr Falk Pharma. Both authors are voluntary advisors to EosNetwork, Euroes and the BSG Guideline Development group, and JE an advisor to ESPGHAN guidelines.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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