Eosinophilic oesophagitis and food allergy

Eosinophilic oesophagitis (EoE) is an allergic condition of the oesophagus. It is a clinicopathological diagnosis, in which intermittent dysphagia and/or food impaction in adults occur in the presence of severe eosinophilic infiltration of the oesophagus. In children, symptoms can be less well defined, with feeding refusal, vomiting and failure to thrive. Symptoms of reflux, often described by both adult and paediatric patients are typically unresponsive to acid suppression treatment. Patients tend to have a history of atopy and both food and aero-allergens are implicated in EoE pathophysiology. EoE is defined as >20 eosinophils per high-power field (eos/HPF) on oesophageal biopsies. Its prevalence is reported at 4/1000 adult population, but its incidence is increasing and it is commoner in males. Although current guidelines require acid reflux to be excluded before a diagnosis of EoE, the two conditions can overlap. Clinical awareness is necessary for the condition to be diagnosed by ensuring oesophageal biopsies are taken even from a normal oesophagus when patients present with symptoms suggestive of EoE. The main treatment options include dietary therapy with elimination or exclusion diets in children, and topical or systemic corticosteroids, with or without concurrent use of PPIs in adults. Endoscopic dilatation of identified strictures is less commonly needed; there is a high risk of perforation associated with this.