Eosinophilic Oesophagitis

Incidence

• 1 in 2,000

• Mostly men in 20s and 30s

Risk Factors

• Limited data

• Antibiotic exposure

• PPI

• NICU admission

• Breastmilk protective

Clinical

• Dysphagia

• Food impaction

• Chest pain

• GORD

• Upper abdominal pain

Children

• Feeding dysfunction (median 2 years)

• Vomiting (Median 8 years)

• Abdominal pain (median 12 years)

• Dysphagia (median 13 years)

• Food impaction (Median 16 years)

Associations

• 75% of patients had a history of an allergic disorder

Diagnosis

• Symptoms, endoscopy and histology

Investigations

• 55% of patients have IgE > 114,000 untis/L

• Mild eosinophilia in 50%

Differential

• These include gastroesophageal reflux disease (GERD), recurrent vomiting due to other causes, parasitic and fungal infections, congenital rings, Crohn disease, periarteritis, allergic vasculitis, drug injury, connective tissue diseases, bullous pemphigoid, pemphigoid vegetans, graft-versus-host disease, achalasia, drug hypersensitivity, celiac disease, vasculitis, carcinoma, and a number of causes of peripheral eosinophilia

Treatment

Dietary therapy

• Immunologist review to evaluate food allergies

• Three main options are

  • Elemental diet

  • Testing directed diet

  • Empiric elimination

    • Wheat (22 to 60%)

    • Cow’s milk (50% of patients)

    • Hen’s egg (5 to 44%)

    • Fish/shellfish (11%)

    • Soy +/- other legumes (10%)

    • Peanut/tree nut (0 to 11%)

  • Australian numbers

    • Wheat 43%

    • Cow’s milk 39%

    • Egg 35%

  • Can do elimination of all

  • Then reintroduce 1 and repeat endoscopy 8 to 12 weeks

Drugs

• PPI for 8 weeks

  • Then Endoscopy

  • Then low dose PPI ongoing

• Topical glucocorticoid

  • Fluticasone via MDI sprayed into mouth and swallowed

  • Don’t eat or drink for 30 minutes

  • Adults 220mcg sprays, four sprays daily in dividend doses