Eosinophilic oesophagitis

Last reviewed: 1 Sep 2022

Last updated: 08 Jul 2022

Eosinophilic oesophagitis (EoO) is a chronic immune-mediated/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and pathologically by an eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes of local or systemic eosinophilia.

To consider the diagnosis, there must be an oesophageal epithelial infiltrate of ≥15 eosinophils per high-power microscopy field on oesophageal biopsy.

Incidence and prevalence are increasing at a rate that is outpacing increased recognition and diagnosis; it is more commonly seen in children and young adults.

Medications (usually topical/swallowed corticosteroids) or dietary elimination can be used as a first-line treatment, with endoscopic dilation reserved for patients with oesophageal strictures or fibrostenotic complications.

Prognosis is good, with the majority of patients having a good response to either pharmacological or dietary elimination therapy.

Definition

Eosinophilic oesophagitis (EoO) is a chronic, immune-mediated/allergen-mediated clinicopathological condition. It is characterised clinically by symptoms of oesophageal dysfunction (e.g., dysphagia and food impaction in adolescents and adults, and vomiting, regurgitation, heartburn, abdominal pain, failure to thrive, or feeding intolerance in children), and histologically by an eosinophilic infiltration of the oesophageal epithelium of ≥15 eosinophils per high-power microscopy field in the absence of other causes of local or systemic eosinophilia.[1][2][3] The condition is also abbreviated to EoE (eosinophilic esophagitis).

History and exam

Key diagnostic factors

presence of risk factors
dysphagia
food avoidance and modification behaviours

More key diagnostic factors

Other diagnostic factors

heartburn
chest discomfort
nausea/vomiting
regurgitation
abdominal pain
failure to thrive
irritability

Other diagnostic factors

Risk factors

family history of EoO
male sex
atopic disease
children and younger adults
white ancestry

More risk factors

Diagnostic investigations

1st investigations to order

oesophagogastroduodenoscopy
oesophageal biopsy
FBC with differential

More 1st investigations to order

Emerging tests

transnasal endoscopy
oesophageal string test
cytosponge
mucosal impedance
EoO diagnostic panel

Treatment algorithm

ACUTE

at initial diagnosis

ONGOING

response to initial therapy

non-response or relapse

Contributors

Authors

Jenny Epstein, MB ChB MRCPCH PhD

Consultant Paediatric Gastroenterologist

Chelsea and Westminster Hospital

London

Disclosures

JE is a member of the advisory board for Dr Falk Pharma, manufacturer of Jorveza, a new formulation of budesonide licensed for adults with eosinophilic oesophagitis (EoO), and Nurtricia for infant functional bowel disorders. She has received honoraria from Dr Falk Pharma to speak on EoO and has been sponsored by Dr Falk Pharma, Abbvie and Nutricia to attend national and international meetings. JE is a member of BSPGHAN IBD working group, medical advisor to CICRA and Coeliac UK, member of CCUK IBD working group, member of BSG EoE Guideline development group, member of NICE Guideline update committee for Crohn’s disease and ulcerative colitis, member of NICE Diagnostics, and sits on the NICE advisory committee for personalised treatment in Crohn's disease.

Acknowledgements

Dr Jenny Epstein wishes to gratefully acknowledge Dr Evan S. Dellon, the previous contributor to this topic.

Disclosures

ESD is an author of a number of references cited in this topic.

Peer reviewers

David Katzka, MD

Professor of Medicine

Mayo Clinic

Rochester

Disclosures

DK has served on advisory boards (Adare, Receptos) and received research funding (Covidien).

Alexandra Papadopoulou, MD

Honorary Professor

Chief of the Division of Gastroenterology and Hepatology

First Department of Pediatrics

University of Athens

Agia Sofia Children’s Hospital

Athens

Greece

Disclosures

AP has received speaker’s honorariums from Nestle and Nutricia; research grants from Biogaia/Nutricia/Abbvie; consultant’s fee from Receptos.

Differentials
- Gastro-oesophageal reflux disease (GORD)
- Eosinophilic gastroenteritis
- Achalasia
More Differentials
Guidelines
- Guideline on informed consent for GI endoscopic procedures
- Clinical guidelines for the management of eosinophilic esophagitis
More Guidelines
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Eosinophilic oesophagitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Emerging tests

Treatment algorithm

at initial diagnosis

response to initial therapy

non-response or relapse

Contributors

Authors

Jenny Epstein, MB ChB MRCPCH PhD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

David Katzka, MD

Disclosures

Alexandra Papadopoulou, MD

Disclosures

Differentials

Guidelines

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