Presentation varies with age of onset:
Adults: heartburn, chest pain, dysphagia, food impactions
Children: difficulty feeding, vomiting, abdominal pain, failure to thrive.
Diagnosis is by endoscopic biopsy showing characteristic histopathology, followed by an 8 week trial of PPI and re-endoscopy to identify persisting eosinophils.
There are currently no clear national or local guidelines on the management of Eosinophilic Oesophagitis (EO).
There is a useful (but wordy) article published by the American College of Gastroenterology.
A treatment algorithm is also under development locally.
This is likely to suggest treatment with steroid inhaler (fluticasone evohaler 250 - 2 sprays twice daily) which is sprayed into the patients mouth and then swallowed (and not inhaled). Patients should not eat or drink for 30 minutes afterwards.
If response within one week then continue for 8 weeks.
If no response then consider referral to dietician.
If response but then relapse when treatment is stopped, then discuss maintenance treatment with steroid inhaler or dietary approach.
(Please note that at present there is no clear pathway for dietician referral for EO locally so referrals to them may be rejected - we hope that this will be resolved shortly - Referral Service Team)
Advice from Michael Sproat, GPSI at PRIME suggests the following:
'GPs typically prescribe inhalers by brand name, and I have come across patients being given "breath-actuated inhalers" which clearly are inappropriate for oral administration even if the dose is correct! My clinic letters therefore advise that patients are given Flixotide (Fluticasone) 250mcg Evohaler two sprays twice daily.
Eosinophilic oesophagitis is diagnosed by endoscopy so if clinically suspected then please refer to the endoscopy page.
Once histological diagnosis has been made then the endoscopist should give advice on treatment. In most cases this can be managed in primary care so secondary care referral is rarely needed.
If further advice on treatment is required then please consider:
- Referral to PRIME community gastroenterology clinic via eRS
- Gastroenterology Advice and Guidance.
- Secondary care referral via eRS should be reserved for patients who do not respond to treatment in primary care