Clinical lesson: eosinophilic oesophagitis, a new diagnosis to swallow

Abstract

Eosinophilic oesophagitis (EoE) is a recently described condition that has gained increasing recognition over the past 5 years. Despite this, many clinicians remain unaware of EoE, often leading to diagnostic delay and therefore significant morbidity. The diagnosis of EoE should be considered in any patient with a history of intermittent or continuous dysphagia, or oesophageal food impaction. It should be strongly suspected in young patients, particularly men, presenting with dysphagia and a history of atopy. Here, three patients are presented that highlight common features of EoE. In addition, a clinical review of the worldwide literature is provided to heighten physician awareness and understanding of the condition.

A debate on the roles of antireflux surgery and long term acid suppression in the management of gastro-oesophageal reflux disease: Table 1

“…It is essential to confirm reflux before subjecting a patient to an operation and this should avoid the errors in management of achalasia or eosinophilic oesophagitis 39. Additionally, the tests may exclude reflux as the cause of symptoms and direct treatment.…”

A case of eosinophilic esophagitis with atypical clinical course

“…For diagnosis of eosinophilic esophagitis, characteristic endoscopic findings and identification of dense eosinophilic infiltration in endoscopic biopsy specimens are considered to be important. Eosinophilic esophagitis is reported to be a chronic disease, with a risk of esophageal stenosis caused by long-standing inflammation-induced fibrosis in the esophageal submucosal layer [3,4]. Fewer than 20 cases have been previously reported in Japan, and all of those patients required drug administration for remission induction, based on a MEDLINE search using ''eosinophilic esophagitis'' and ''Japanese'' as keywords.…”

Young man presenting with recurrent food bolus impaction

“…EoE has been described worldwide, with the exception of Africa and, although the prevalence of this condition is low (0.4-0.7%), 1 it appears to be increasing. The patient group demonstrates a male predominance (70%) 2 and familial clustering has been noted in some studies. There is clearly a link with atopy, with many patients having an extensive personal and family history of atopic conditions, including asthma, seasonal allergic rhinitis and/or eczema.…”