Eosinophilic oesophagitis (EoE)
Eosinophilic oesophagitis is a chronic, immune‑mediated inflammatory disease of the oesophagus characterised by dense eosinophilic infiltration of the mucosa. Recognition has increased over the past two decades.
The condition commonly presents with oesophageal dysfunction (dysphagia, food‑bolus impaction, refractory heartburn) and is strongly associated with atopic disease. Definitive diagnosis requires upper GI endoscopy with oesophageal biopsy and histological confirmation.
Epidemiology and aetiology
- Most commonly diagnosed in young to middle‑aged adults (typical age 30-50 years), but occurs at any age including children.
- Male predominance of approximately 3:1.
- Strong association with atopy (asthma, allergic rhinitis, eczema).
- Pathogenesis is antigen‑driven Th2 inflammation with eosinophil recruitment; the condition is not purely IgE‑mediated.
Clinical features
Adults
- Progressive dysphagia, classically for solids.
- Recurrent food bolus impaction (a common emergency presentation).
- Heartburn or reflux symptoms refractory to standard antacid therapy.
- Non‑cardiac chest pain.
- Long‑standing disease may cause concentric rings, strictures and impaired bolus transit.