Introduction Eosinophilic oesophagitis (EoE) is a chronic condition of the oesophagus characterised by a dense eosinophilic infiltrate defined as >15 eosinophils/high power field (eos/hpf). The aim of this study was to capture the prevalence of EoE in a tertiary referral centre in London, to identify factors associated with a positive diagnosis and interrogate optimal response to therapy.
Methods From February 2013 to November 2015, all patients presenting with solid food dysphagia to University College Hospital had a high resolution white light endoscopy. Those with cancer, achalasia, postoperative stricture or endotherapy for Barrett’s were excluded. Endoscopy, histology and clinical data were collected. >15 oes/hpf were defined as positive for EoE. A separate histopathology search identified patients with >15 eos/hpf and no dysphagia. A prospective follow-up was conducted in focusing on therapy and response in those with >15 eos/hpf.
Results Out of the 1566 patients with dysphagia, 524 were excluded for reasons stated. 736/1042 (71%) had oesophageal biopsies. Of those, 67 (9.1%) had more than 15 eos/hpf. Another 14 patients with >15 eos/hpf with symptoms other than dysphagia were identified from histology records, making the total number with eosiniphilia 81. The mean number of biopsies taken in those with >15 eos/hpf (6.3) was greater than those with <15 eos/hpf (5.1; p = 0.003). EoE patients were more likely to be male (70%) and younger (43±16 years) compared to nonEoE (40% male, p < 0.0001; 59±16 years, p < 0.0001). Typical endoscopic features were found in 39 (48%) EoE patients; rings/furrows in 26 (32%) and strictures in 15 (18%). 42/81 (52%) were treated with PPIs only of which 19 (45%) clinically responded. 18 (22%) patients had both PPI and topical steroids (12 had steroids after PPI failure) while 8/81 (10%) had steroids only. Clinically 14/26 (54%) responded optimally to topical steroids, 13 of which had dysphagia. Overall, response to steroids occurred in those with a higher eosinophilia (53 vs 24, p = 0.004) and all 9 with ≥40 eos/hpf had a complete response. Furthermore, typical EoE findings at endoscopy was more likely to be associated with a poor response to PPIs (p < 0.0001).
Conclusion A higher number of biopsies taken raises the diagnostic yield; however still up to 1/3 patients in a modern referral centre have no biopsies taken. EoE should be excluded in those with no dysphagia and refractory reflux symptoms. Although PPIs are provided as first-line therapy, a positive response to steroids is more likely in those with higher numbers eos/hpf, while those with fewer numbers and no endoscopic features could be considered for PPI therapy first. Such findings might be a useful tool to help tailor therapy.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.