• DRUG DEVELOPMENT
• INFLAMMATORY MECHANISMS
• OESOPHAGEAL DISORDERS
• PHARMACOTHERAPY

Once regarded as a rare disease, the incidence and prevalence of eosinophilic oesophagitis (EoE) have risen consistently over the past 25 years.1 It is now the second most common disease of the oesophagus after gastro-oesophageal reflux disease, and the most likely cause of thoracic dysphagia and of food bolus obstruction presenting to emergency departments.2 With the burden ever growing, it behoves clinicians who may see patients with symptoms suggestive of EoE to be aware of the condition, how it should be diagnosed and what the options are for treatment.

Confirmation of diagnosis is straightforward. A dense infiltration of eosinophils within the oesophageal epithelium with a peak count of ≥15 eosinophils/0.3 mm² in any biopsy specimen is the distinguishing feature of EoE.2 While other conditions may also cause a degree of oesophageal eosinophilia, the threshold figure is a useful cut-off for diagnostic certainty.

Recent guidelines on EoE from the British Society of Gastroenterology/British Society of Paediatric Gastroenterology, Hepatology and Nutrition effectively standardise the diagnosis and assessment of the condition.2 However, they are less definitive about treatment since outcomes with traditional EoE therapies are relatively poor.

Proton pump inhibitors are a case in point. They result in at least partial symptom improvement in ~70% of patients with EoE, but histological remission in fewer than 50%.3 With an absence of clear usage instructions, off-label topical …