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PTU-146 Incidence and Predictors of Eosinophilic Oesophagitis in Dysphagia: A Prospective Analysis
  1. I A Murray1,2,
  2. S Bennett1,
  3. J Palmer3,
  4. M Lau4,
  5. M Schultz1
  1. 1Gastroenterology, Dunedin Hospital, Dunedin, New Zealand
  2. 2Gastroenterology
  3. 3Research and Development, Royal Cornwall Hospital, Truro, UK
  4. 4Pathology, Dunedin Hospital, Dunedin, New Zealand

Abstract

Introduction Eosinophilic oesophagitis (EO) causes dysphagia: 10–15% in European and US studies. It is diagnosed by finding > 20 eosinophils per hpf in oesophageal biopsies. We prospectively examined the incidence and clinical indicators of EO in a New Zealand population.

Methods Interim analysis of demographics, symptoms and associated diseases by questionnaire prior to endoscopy in 75 consecutive patients with dysphagia. Endoscopic findings were recorded with histology.

An initial analysis was performed to investigate whether age and gender of patients and symptoms (duration of dysphagia, intermittent or progressive symptoms, level of dysphagia, weight loss, choking, reflux odynophagia or a history of allergy) were associated with a final diagnosis of EO using chi squared or Fisher’s exact test as appropriate then logistic regression used to determine the final model.

The sensitivity and specificity of endoscopic changes (furrows, ridges and rings) was determined separately and significance determined by Fisher’s exact test.

Statistical significance was taken as P < 0.05. Ethics approval was obtained.

Results 75 patients, mean age 56 (range 15–94 years), 31 male (41%), had gastroscopy because of dysphagia. 64 (85.3%) completed the questionnaire and 67 (89.3%) had endoscopic biopsies. 12 (16%) had EO, mean age 36.7 years (range 18–62), 8 male. Endoscopic abnormalities suggestive of EO were seen in 7 EO patients (sensitivity 38.9%, specificity 91.2%: P < 0.01).

Allergy/atopy (hayfever, asthma, eczema, coeliac) was no more common in EO (54.5%) than those without (49.0%). The level of dysphagia was not pharyngeal in 5 EO patients. Duration of dysphagia was at least 6 months in all bar one EO patient (range 26 – 1248 weeks). Weight loss of 7–10 kg was reported by 4 EO patients. No patient responding to PPI therapy had EO. The strongest predictor of EO was age under 50 (OR 20.0 95% CI 3.4–117.8) with male sex also being significant (OR 6.7 95% CI 1.4–32.3). No other factor was statistically significant.

Conclusion EO is present in a dysphagic New Zealand population with a relatively high incidence. It is more common in younger males but there was no obvious association with allergy. Although endoscopic changes associated with EO were highly specific they were not sufficiently sensitive to depend upon. We would recommend oesophageal biopsies in all patients presenting with dysphagia without obvious cause at endoscopy.

Disclosure of Interest None Declared

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