Eosinophilic Esophagitus

Question 1

Risk factors for developing eosinophilic oesophagitis

Answer 1

Allergies/ asthma: suffering from food/ environmental allergies or atopic dermatitis and asthma increases the risk of diagnosis
Male sex
Family history of eosinophilic oesophagitis or allergies
Caucasian race
Age between 30-50
Coexisting autoimmune disease e.g. coeliac disease

Question 2

X

Question 3

X

Question 4

Presentation of eosinophilia esophagitis

Answer 4

Adults often experience dysphagia, strictures/ fibrosis (56%),
food impaction (55%),
regurgitation/ vomiting,
anorexia / weight loss

Question 5

Investigation findings on endoscopy ?

Answer 5

reduced vasculature,
thick mucosa,
mucosal furrows,
strictures and laryngeal oedema.

Histologically, the diagnosis is made more likely in the presence of epithelial desquamation, eosinophilic microabscesses, and abnormally long papilla

Question 6

Management

Answer 6

PPI trial

persistence of eosinophilia and no improvement of symptoms after trialling a proton pump inhibitor. This can help the clinician differentiate between eosinophilic oesophagitis and GORD

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Dietary modification

Topical steroids e.g. fluticasone and budesonide

Oesophageal dilatation

Question 7

Complication of eosinophilia esophagitis

Answer 7

Strictures of the oesophagus (56%)

Impaction: 55% of patients experience this, and 38% of these require endoscopic removal of the impaction

Mallory-Weiss tears

Question 8

Prognosis

Answer 8

condition is likely to come back in patients that stop treatment so it important to gain a good balance of dietary modifications and additional pharmacological treatments when necessary.