Diagnosis and management of eosinophilic oesophagitis

Eosinophilic oesophagitis is a chronic inflammatory disease related to food allergy that should be suspected in patients presenting with food bolus impaction, or a history of dysphagia with or without atopy. The 6 most common food triggers are animal milk proteins, wheat, eggs, soy, nuts and seafood. Eosinophilic oesophagitis is a histological diagnosis with at least 15 eosinophils (60 eosinophils per mm2) per high-power field on oesophageal biopsy. Alternative causes of oesophageal eosinophilia should be excluded. Patients with eosinophilic oesophagitis require lifelong management. Depending on patient preference, this may involve dietary exclusion of confirmed food trigger(s) or pharmacological treatment. The mainstays of pharmacological treatment are swallowed topical corticosteroids and proton pump inhibitors, but several monoclonal antibodies are currently under investigation for treatment of eosinophilic oesophagitis.