Symptoms and diagnosis of eosinophilic oesophagitis in adults

Eosinophilic oesophagitis occurs most commonly in patients with a history of atopy and is believed to be related to dietary allergens or aeroallergens. Eosinophilic oesophagitis is more common in children, in whom the symptoms may be indistinguishable from gastro-oesophageal reflux, and in young males, who often present with dysphagia or, occasionally, food impaction. Patients with troublesome dysphagia (which may be masked by slow eating and excessive chewing of food), or who experience an episode of complete or transient food impaction should be referred to a gastroenterologist. Endoscopy may show characteristic changes; however, diagnosis requires oesophageal biopsies (including biopsy of the mid and upper oesophagus) showing an increase in eosinophils (more than 15 per high power field) throughout the oesophagusPhilpott, 2015.

Symptoms of eosinophilic oesophagitis range from mild, which can be controlled with dietary modification or intermittent therapy, to severe and constant, which are sometimes associated with recurrent food impaction.

Symptoms are not a reliable guide to the severity of inflammation. Ongoing inflammation may lead to remodelling and fibrosis of the oesophageal mucosa.

Eosinophilic oesophagitis is chronic and requires long-term follow-up. Management is determined by the severity of symptoms, inflammation and complications.

For information about eosinophilic oesophagitis in children, see here.