- Chronic immune mediated oesophageal disease characterized by symptoms of dysfunction or dysmotility. Histology identifies a predominately eosinophilic inflammation.
- More common in young men.
- Common presentation is often with a food bolus, often with persistent dysphagia and reflux disease (which fails to respond to PPI therapy).
- Often has a history of atopy/asthma.
Diagnostic criteria
- Symptoms related to dysfunction
- Biopsy >15 eosinophils per high powered field – persistent after treatment with PPI therapy.
- Secondary causes of oesophagus eosinophilia need to be excluded – GORD, achalasia, IBD, drug reaction, connective tissue disease like scleroderma, parasitic infections.
Typical endoscopic findings
- Concentric oesophageal rings
- Focal strictures.
- Exudates (white spots or plaques)
- Longitudinal furrows
Management of oesophagitis
- Referral to immunologist
- Dietary modification – six food elimination diet - wheat, milk, eggs, nuts, soy, fish, and shellfish (NB: Not diary)
- Swallowed fluticasone (not inhaled with a spacer, but is swallowed) or Budesonide.
- PPI – if patient is getting associated reflux disease then this might exacerbate symptoms.
- If patient has a stricture – can be dilated.