Eosinophilic oesophagitis: a common cause of dysphagia in young adults?
Eosinophilic oesophagitis (EO) is an increasingly recognised chronic, relapsing inflammatory condition of the oesophagus. There has been a mini-epidemic of EO in the last decade. The incidence of this condition is higher in children and is commoner in males. There is either a family or personal history of atopic conditions present in a significant number of patients and can also be familial in up to 10%. The classical symptom in an adult is chronic, intermittent solid-food dysphagia and food impaction, often necessitating emergency endoscopic removal. Despite the history of dysphagia for a number of years, patients remain well with no weight loss, which can mislead clinicians to diagnose a functional problem with a resulting delay in the diagnosis. There are various endoscopic features of EO; commonly multiple rings and linear furrows, though these can be subtle and the mucosa may be macroscopically normal. The hallmark of this condition is the histological presence of > or =15 eosinophils/high power field (HPF) in the oesophageal mucosa. Therapeutic options include avoidance of dietary allergens, topical or systemic steroids, Montelukast, Mepolizumab (anti-IL-5 antibody) and endoscopic dilation of strictures unresponsive to medical therapy.
Department of Gastroenterology, St Thomas' Hospital, London, UK. kpbasavaraju@talk21.com
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Basavaraju
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Wong
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004941:Esophagitis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult