Introduction Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease associated with oesophageal dysfunction, most commonly dysphagia. Recent consensus guidelines recommend obtaining biopsies from both the proximal and distal oesophagus in patients with dysphagia who have normal endoscopies.1 This study aims to investigate the adherence to these guidelines and familiarise clinicians with this pathology.
Methods The study included 2 cycles, each of 6 months. Cycle 1 was from 1/5/12 until 6/11/12. Cycle 2 extended from 1/1/13 until 6/7/13. For each cycle the hospital database was used to review the records of all patients that underwent endoscopies for dysphagia as the primary symptom. All normal endoscopies were included. The number of biopsies and histology results were recorded. Following the first cycle recommendations and information was displayed in all endoscopy rooms and the results fed back to the lead clinicians before cycle 2 was carried out.
Results In Cycle 1, 258 patients underwent endoscopies for dysphagia with 75 considered endoscopically normal. In cycle 2, 263 endoscopies were carried out, of which 74 appeared normal. Biopsies were taken from 27% (n = 20) of the normal endoscopies in Cycle 1, with 5% (n = 1) of those biopsied proving histologically positive for EoE. This increased in Cycle 2 to 45% (n = 33) biopsied and EoE present in 12% (n = 4).
Conclusion Eosinophilic oesophagitis is an important diagnosis that may result in complications if missed and not specifically treated. Oesophageal biopsies are underperformed in patients with normal endoscopies. An improvement in biopsy rates through education has increased the number of successful diagnoses at this Trust. However, continued improvement is required as clinicians need to be vigilant regarding this this pathology when developing a differential diagnosis for dysphagia.
Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). American Journal of Gastroenterology 2013;108(5):679–692
Disclosure of Interest None Declared.
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