Makindo Medical Notes.com

With each meal, more sticks
Turkey bites pile on like bricks
Chunks just will not move
Such relief EGD brings
Their view looks like feline rings
@DrCindyCooper

About

• Inflammation of the oesophagus
• Antigens from various foods (eg milk, wheat, soy, eggs and seafood) have been implicated.

Incidence

• Usually white men age 30-50
• Incidence 7/100,000 per annum

Aetiology

• Several genes contribute: CAPN14 and TSLP.
• Loss of oesophageal barrier function due to loss of anti-proteases
• Elevated expression of eotaxin-3

Diagnostic criteria: Includes all of the following:

• symptoms related to oesophageal dysfunction
• >15 eosinophils/hpf on oesophageal biopsy
• persistence of eosinophilia after a proton pump inhibitor trial
• secondary causes of oesophageal eosinophilia excluded.

Clinical

• Dysphagia, food impactions, reflux, chest pain
• Food bolus impaction due to a narrow-calibre oesophagus and dysmotility

Investigations

• Upper GI Endoscopy OGD
  • Ringed oesophagus and linear furrows on endoscopy.
  • Longitudinal furrows, Trachealisation, White exudate
  • Wall friability, Narrowing, Loss of vascular pattern
• Biopsy: > 15 eosinophils/hpf on histology (biopsy)

Causes of oesophageal Eosinophilia

• Eosinophilic oesophagitis
• Gastro- oesophageal reflux disease
• Proton pump inhibitor-responsive oesophageal eosinophilia
• Achalasia
• Crohn’s disease
• Parasitic infection
• Drug hypersensitivity
• Connective tissue disease (eg scleroderma, dermatomyositis)
• Coeliac disease
• Hypereosinophilic syndrome

PPI treatment for a period of 8 weeks (as per ACG guidelines) preceding the diagnosis of EoE is important to distinguish between true EoE and GORD

Management

• Remove any allergy cause and consider allergy testing, elemental diet, and empirical food elimination of milk, wheat, soy, eggs and seafood
• Consider PPI which may help and helps exclude GORD
• Consider steroids as an asthma inhaler e.g. fluticasone, budesonide given with an MDI but without the spacer. Most patients are treated with an 8-week course of topical steroids and re-assessed.
• Endoscopic dilation if needed. Oesophageal dilation is very effective in widening the oesophageal diameter and providing rapid relief of dysphagia. It is usually reserved for patients who have failed more conservative measures, or whose oesophageal stenosis is critical.

References

• Eosinophilic oesophagitis – A guide for primary care
• Eosinophilic Oesophagitis