Introduction Eosinophilic oesophagitis (EO) is a chronic relapsing,immune/antigen mediated disease of the oesophagus with rapidly increasing incidence and prevalence; however EO often remains under-diagnosed. Early detection and appropriate therapy improves quality of life and may prevent development of chronic oesophageal changes. A diagnosis can only be made when a dense eosinophilia is confirmed on histology in the context of typical symptoms (e.g.solid food dysphagia)1.We prospectively assessed the prevalence of EO in patients presenting to endoscopy at a tertiary referral centre with solid food dysphagia over 2 years.
Methods Between Jan 2010 and Dec 2011,746 patients with dysphagia (including food bolus obstruction)had high definition white light endoscopy performed. Patient demographics,symptomatology,endoscopic and histological findings were recorded.EO was defined as the presence of > 15 eosinophils per high power field
Results Patients with oesophageal malignancy (n = 65),barrett’s oesophagus(n = 48) and post-oesophageal surgery complications (n = 16) were excluded. Of the 628 remaining patients,388(62%) (254 male; mean age 59; range 18–88) had mid-oesophageal biopsies taken.23/388 (5.9%)were diagnosed with EO 19 male; mean age 40; range 26–56).Endoscopy showed mucosal pathology in 12/23 (52%)patients with confirmed EO; oesophagitis (n = 3),red furrows (n = 3),distal narrowing (n = 2),corrugated rings (n = 2),mucosal tear (n = 1) and white exudates (n = 1).250 of the remaining patients had grade A or B oesophagitis. Overall 17 patients had food bolus obstruction.11/17 patients had biopsies taken and 5/11(46%) showed histological evidence of EO.4/5 patients with bolus obstruction had distal oesophagitis on endoscopy but EO was confirmed following ≥4 mid-oesophageal biopsies. There was a trend towards those with EO having had a greater number of biopsies taken (mean 6.14; range 2–12) compared to those without EO (mean 5.02; range 2–8; p = 0.082).28% and 51% had ≤3 and ≤4 biopsies collected respectively. The mean (±SD) number of eosinophils/hpf in the EO group was 64.3 (51.3).
Conclusion Mid-oesophageal biopsies can diagnose EO in at least 1 in 16 cases of patients with unexplained solid food dysphagia.However,1/3 of patients in whom EO should have been considered (including 6 with food bolus obstruction)did not have biopsies collected.Furthermore, 1/4 had less than the recommended minimum 4 mid-oesophageal biopsies. In summary, our experience has shown that EO detection is likely to improve further if all patients with symptoms conducive with EO (e.g.solid food dysphagia) routinely trigger an EO biopsy protocol of ≥4 from the mid-oesophagus regardless of endoscopic findings.
Disclosure of Interest None Declared
Liacouras CA, Furuta GT et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128(1):3–20 e6.
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