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Feature Article

Eosinophilic oesophagitis: diagnosis and management

Astrid-Jane Greenup, Christopher S Pokorny

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Abstract

Eosinophilic oesophagitis is an immune-mediated disease that is increasingly being recognised and should be considered in any patient presenting with a swallowing difficulty. Diagnosis relies on endoscopy and histological examination of oesophageal biopsy specimens. Treatment options include medication, diet and oesophageal dilatation.

Key Points

  • Eosinophilic oesophagitis (EoE) is an increasingly recognised cause of dysphagia and food impaction; other presentations include chest pain and refractory heartburn.
  • EoE is associated with atopic conditions such as asthma, allergic rhinitis and atopic dermatitis.
  • As dysphagia is an alarm symptom, affected patients should be referred for investigation, particularly to exclude oesophageal malignancy.
  • Diagnosis of EoE relies on clinical and pathological features.
  • Typical features include oesophageal rings, linear furrows, white exudates andcrepe-paper mucosa seen on endoscopy, and eosinophil-predominant inflammation on histological examination of biopsy specimens.
  • Treatment options include diet, drugs and oesophageal dilatation; long-term strategies may be needed to prevent complications such as oesophageal stricture.

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