Introduction Eosinophilic Oesophagitis (EoE) is an increasingly common cause of dysphagia. Most reported series are from specialist centres. We present a series of adult patients with EoE from a typical UK district general hospital, describing their demographics, investigations and treatment response. We also highlight the role of Total IgE measurement in supporting the diagnosis.
Method Patients were selected retrospectively by reviewing biopsies from endoscopies performed over a 4 year period (2009–2012). Diagnosis of EoE was confirmed by having oesophageal symptoms, 15 or more eosinophils per high powered field and absence of an alternative diagnosis.
Results 73 cases were identified, 52 were male and 21 female. Average age at presentation was 51 years. Presenting symptoms included dysphagia (n = 58), bolus obstruction (n = 34) and reflux (n = 19). We estimate EoE is responsible for 3% of cases of dysphagia presenting to our hospital.
49 patients were asked about atopy history. 37 (76%) had a positive history for at least one condition; hay fever (n = 19), asthma (n = 18), eczema (n = 8), urticarial (n = 4) and/or dermatitis (n = 1).
Total IgE was measured in 31/65 (48%) patients who had blood tests. 30 (97%) had either a strongly positive (n = 27) or positive (n = 3) total IgE reading, defined as total IgE > 0.35 kU/L. Levels ranged from 5–520 kU/L. 23/31 (74%) of these cases had history of atopy. Food mix allergy testing was done in 29/73 with a positive result in 16.
First line treatments prescribed were documented in 62 cases as shown:
Those not responsive to combination therapy of PPI and swallowed steroid as first line agents had antihistamines, domperidone or cromoglycate added.
Conclusion EoE is a common and treatable cause of dysphagia. This study supports that adult EoE patients have atopic coexistence, more often reported in paediatric studies. Total IgE measurement may be useful in supporting a diagnosis. Only 3 previous studies have reported total IgE levels in EoE patients. Food specific radioallergosorbent testing (RAST) may have a role in management of EoE with dietary exclusion a treatment option. This is well described in the paediatric population but less so in adults – only one adult study has described use of food specific RAST in adult EoE patients. Given the variability in treatment approach to EoE there is a clear need for guidelines to standardise the care of EoE.
Disclosure of interest None Declared.
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