Eosinophilic oesophagitis (EO)

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What is Eosinophilic oesophagitis?

Eosinophilic oesophagitis (EO), also known as eosinophilic esophagitis (EE), is a specific inflammatory condition of the oesophagus where the wall becomes filled with eosinophil cells. The oesophagus is the muscular tube extending from the throat to the stomach which is important in swallowing. Eosinophils are a specific type of white blood cell involved in inflammatory changes, particularly those associated with allergic reactions.

Who gets Eosinophilic oesophagitis?

EO was first reported in 1978 and now is recognised worldwide. The incidence of EO appears to be increasing along with a range of other allergic disorders in developed countries. A Western Australian study showed the incidence of EO in kids increased by a factor of almost 18 from 1995 to 2004. In recent years there has been increasing recognition of the disease in adults.

For unknown reasons EO is more common in men who are affected approximately three times more commonly than women. The majority of patients with EO are therefore young boys or men.

Predisposing Factors

The exact cause of EO is not known. Studies have shown that food allergy (in particular to cow's milk, soy, wheat and egg) may be associated with the disorder. Approximately 68% of patients will have other allergic disease such as rhinitis, bronchial asthma and atopic dermatitis. Other contributory factors may include genetics, environmental antigens or abnormal immunological responses.

Progression

EO can present in a variety of ways. In young children symptoms are usually similar to those of gastro-oesophageal reflux disease (GORD) such as upper abdominal pain, regurgitation, vomiting or chest pain. During adolescence symptoms of dysphagia (difficulty swallowing) become more prominent and adults tend to present with symptoms of dysphagia and strictures. It is common for patients with this EO to have a history of other allergic symptoms such as hayfever or food allergy You may also have a family history of EO or other allergic conditions.

EO produces intermittent symptoms and usually follows a chronic and relapsing course. You may gain some symptomatic relief from acid-blocking medications but these do not alter the changes in the oesophagus.

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