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Eosinophilic Oesophagitis

What is Eosinophilic Oesophagitis?
Eosinophilic oesophagitis is a chronic inflammatory condition that affects the oesophagus (food pipe). This condition is characterised by white blood cells known as “eosinophils” being present in the lining of the oesophagus due to allergy or infection. Eosinophilic oesophagitis seems to be more common in people with allergic conditions such as food allergy, eczema, allergic rhinitis or asthma.

What are the symptoms Eosinophilic Oesophagitis?
The initial symptoms of eosinophilic oesophagitis may occur at any age. In young children, the condition should be considered if there are reflux-like symptoms (e.g. vomiting, regurgitation, abdominal discomfort) or persistent feeding problems. In older children and adults, difficultly swallowing and food impaction in the oesophagus are the symptoms. Eosinophilic oesophagitis should also be considered in people with gastro-oesophageal reflux disease who are not responding well to treatment.

How is Eosinophilic Oesophagitis diagnosed?
This diagnostic criteria for eosinophilic oesophagitis are:

> Characteristic symptoms
> Endoscopy – there are several characteristic findings at gastroscopy which can suggest Eosinophilic Oesophagitis.
> Large number of eosinophils in oesophageal biopsies – these biopsies can be performed during a Gastroscopy procedure. Oesophageal Eosinophils may also be seen in gastro-oesophageal reflux disease.
> Specific blood tests – (e.g. eosinophil count, IgE level) may provide supportive evidence for the condition. Finally, it is also important to exclude other conditions which may have symptoms similar to eosinophilic oesophagitis.

How is Eosinophilic Oesophagitis treated?
The mainstay of treatment for eosinophilic oesophagitis is will topical steroids (e.g. fluticasone inhalers). These medications are also used in asthma and chronic lung disease, but the patient is taught to “swallow” rather than “inhale” the medications. Acid suppressing medications may also be used if symptoms are also thought to be due to co-existing reflux. If the oesophagus has narrowed then an “oesophageal dilatation” procedure may be indicated. In children, dietary therapy/elimination diet may be effective, although the approach may be difficult to maintain in the long term.

Is there a cure for Eosinophilic Oesophagitis?
Eosinophilic oesophagitis is a chronic condition. A trial of cessation of medication is often considered following an adequate response. However, relapse is common, and repeated courses or long term medication is may be required.

Can Eosinophilic Oesophagitis cause cancer?
There are no reported evidence of a link between eosinophilic oesophagitis and cancer.

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