Eosinophilic oesophagitis

Mr Matthews, a 19 year old man presents with 2 year history of intermittent dysphagia. His endoscopy showed:

What is the diagnosis?
Eosinophilic oesophagitis. The picture shows a ringed appearance i.e. trachealized oesophagus.

Discuss the endoscopic findings in eosinophilic oesophagitis?
Endoscopic findings are usually subtle and a careful examination is needed along with biopsies. Endoscopic findings include:

  • Strictures
  • Trachealized oesophagus (ringed appearance)
  • Whitish elevated papules that resemble candidiasis
  • Longitudinal linear furrows (also called oesophageal corrugation)

How do you establish the diagnosis?
At least 5 biopsies should be obtained from the proximal and distal third of the oesophagus for optimal sensitivity.
The current accepted number of eosinophils needed for diagnosis is 15 eosinophils/HPF in the presence of a consistent clinical context.

Oesophageal biopsies should be obtained if the clinical history is suggestive (even if the oesophagus looks normal endoscopically)

What is Eosinophilic oesophagitis?

  • Chronic oesophageal inflammation of unknown origin that is characterized by dense infiltration of eosinophils.
  • It has been described in patients of all ages, however it is most common in the childhood
  • It predominantly affects males
  • Possibly allergic in aetiology as majority of patients have a personal or family h/o allergy
  • New disease with an increasing incidence

Discuss the clinical manifestations of EO?

  • Intermittent dysphagia
  • Food impaction
  • GORD like symptoms unresponsive to PPI
  • Vomiting
  • Chest pain

Further reading
Link to Eosinophilic oesophagitis

Image courtesy of www.gastrointestinalatlas.com

Submit your learning module

Play a role in the development of Gastrotraining.com by publishing your learning module.

Post a Comment