Introduction Eosinophilic Oesophagitis (EoE) is an under recognised condition. There are clues in the history, biochemistry, immunology and gastroscopy to make the diagnosis. Strictures associated with this condition need careful endoscopic management.
Methods Retrospective review of histology proven eosinophilic oesophagitis cases between April 2009 and June 2011.
Results Total no of patients 16, Male: female=7:1. Age range: 18–89 years (IQR 24.25 (24.75–49). Mean age 41.5 years. All of them complained of intermittent dysphagia and 50% of them had a history of food bolus impaction on presentation. Only 25% had symptoms less than a year. 18.75% (3/16) had symptoms for more than 10 years.10/16 (62.5%) had a history of atopy. 2/16 (12.5%) had food intolerance/oral allergy especially for fruits. 6/16 had oesophageal manometry; 5/6 of them had normal manometry findings and one showed dysmotility. 50% had barium swallow; two of them showed mild dysmotility. 7/16 had high peripheral eosinophil count (0.04–0.4). Mean 0.58. Only 56% (9/16) of patients had IgE levels checked, 8/9 had high IgE levels. All of them were treated with proton pump inhibitors, while 75% needed fluticasone inhaler. 25% needed montelukast maintenance therapy to achieve clinical benefit. 25% showed normal gastroscopy, remainder showed characteristic findings such as concencentric rings, furrows with ulceration. 25% had symptomatic oesophageal strictures; two of them had balloon dilatation previously. The other 2 (50%) were successfully treated with biodegradable stent. One patient had sustained response with single stent even after 18 months, the other had two sequential stents (8 months apart) to improve the symptom of dysphagia.
Conclusion To diagnose the condition history is crucial, while laboratory and gastroscopy add more strength. Fluticasone inhaler, exclusion diets and montelukast help in the majority of patients. Strictures associated with EoE can be successfully treated with biodegradable stent.
Competing interests None declared.
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