Eosinophilic Oesophagitis (EoE): An update

Abstract

EoE is a relatively newly recognised chronic immune mediated disease, which is increasing in incidence and prevalence in western populations. It frequently presents in Caucasian males between the third and fourth decade with a history of atopic disorders. Symptoms are related to oesophageal dysfunction and commonly include dysphagia and food bolus impaction. Recognition of food or aero allergens by the immune system triggers a Th2 response which is mediated by a number of cytokines including IL-5, IL-13 and eotaxins. The resulting eosinophil predominant chronic inflammation leads to oesophageal remodelling and is responsible for the clinicopathological features of the disease. The key histopathological feature of EoE is 15 eosinophils/high power field in the oesophageal mucosa. Endoscopic features, whilst not diagnostic, are nonetheless highly characteristic and include the loss of the normal vascular pattern, fragility of the mucosa and fixed oesophageal rings. Prompt diagnosis and treatment are important, as untreated disease leads to fibrostenotic complications. The mainstay of treatment for EoE is topical steroid therapy which has been proven to be effective in both reducing eosinophilic inflammation and improving symptoms. Long- term use may be needed however; as there is a high relapse rate on discontinuing therapy. Other pharmacological treatments such as sodium cromoglycate and thiopurines are either ineffective, of limited benefit or have insufficient evidence of efficacy. Some patients with EoE respond to PPI therapy and may represent a distinct condition called PPI responsive oesophageal eosinophilia (PPI-REE). The six food elimination diet (SFED) is effective in improving histological appearances and symptoms.