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PTU-168 ‘Tomatoes Wearing Sunglasses’ Are Hard to Swallow – an Analysis of the Prevalence, Presenting Features & Investigation Findings in Patients with Eosinophilic Oesophagitis at a District General Hospital
  1. R Nathwani1,
  2. I Al Bakir1,
  3. R Swamy2,
  4. R Dent3,
  5. D L Morris1
  1. 1Gastroenterology
  2. 2Pathology
  3. 3Respiratory Medicine, Lister Hospital, Stevenage, UK

Abstract

Introduction Eosinophilic Oesophagitis (EoE) is a recently described disorder of unclear aetiology and prevalence. Most published studies emanate from international and tertiary referral centres, with a greater focus on the paediatric population, where the disease is better described. We present one of the largest case series of adult patients with EoE managed in a typical UK district general hospital. We describe the patient demographics, presenting features and investigation findings.

Methods We performed a retrospective analysis of clinical records at the East and North Hertfordshire NHS trust from January 2009 to December 2012 to identify patients with EoE. The diagnosis of EoE was confirmed by symptoms, the presence of more than 15 eosinophils (likened by pathologists to “tomatoes wearing sunglasses”) per HPF on oesophageal biopsy, and the absence of an alternative diagnosis. Data fields collected included gender, history of atopy, presenting symptoms, endoscopic findings, peripheral eosinophil count, and serum allergy testing.

Results We identified 45 patients with EoE in this 3 year period. With an estimated catchment population of 545,820, the prevalence of EoE in our local population is about 0.8 per 10,000 people. 33 patients were male and 12 were female, giving an approximate male:female ratio of 3:1. The average cohort age was 52 years. Presenting symptoms were dysphagia in 82% (n = 37), food bolus obstruction in 36% (n = 16), reflux in 24% (n = 11) and abdominal pain in 9% (n = 4). The time to diagnosis ranged from 0 to 15 years.

On endoscopy, 71% (n = 32) had typical features of EoE. The remaining 29% had a normal gastroscopy. We estimate that EoE is responsible for about 2% of all gastroscopies performed for dysphagia at our trust.

32 patients were questioned about a history of atopy; 81% (n = 26) had a confirmed history. Of the 41 patients who had a full blood count cheque, 15% (n = 6) had a peripheral eosinophilia. Total IgE levels were checked in 17 patients; 16 (94%) had elevated levels. Food allergy testing for cod, wheat, egg, soya, milk and nuts was performed in 15 patients. 9 of these patients (60%) had a positive test, the most common allergens being wheat (n = 7) and egg (n = 5).

Conclusion EoE is a common diagnosis in patients presenting with dysphagia. This case series highlights the importance of obtaining oesophageal biopsies when endoscopic appearances are normal. Given the prevalence of EoE, and the variation in assessment even within one trust, national guidelines are required to standardise diagnostic and management pathways for patients with EoE.

Disclosure of Interest None Declared.

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