Eosinophilic Oesophagitis: Two Decades at Ireland’s Largest Tertiary Referral Centre
TJ Matthews, N Conlon, C Donohoe, C Dunne, K Hartery, D Kevans, F MacCarthy, D O’Toole, N Ravi, S McKiernan
Department of Gastroenterology, St James’s Hospital, Dublin
Eosinophilic oesophagitis is an inflammatory condition characterised by an eosinophilic infiltrate, dysphagia and food impaction.
We aimed to audit treatment against European and American guidelines.
Our histology database yielded 68 patients with clinicopathological diagnoses of EoE over the years 2000 to 2021.
Ordinary least squares regression evidenced a significant increasing trend in incidence (c. 1 case per 3 years, p < 0.0001) with a projection of 10 per year by 2032. 17% (n=11) had a documented history of helicobacter, lower than the estimated local seroprevalence of 50%. 76% were male. Median age at diagnosis was 34 (IQR 26–44). 88% (n=58) complained of dysphagia. 23% (n=13) had histories of asthma, eczema or rhinitis. 21% (n=14) had prior food bolus obstruction. 20% (n=13) had stricture with 14% (n=9) requiring dilatation. Median IgE level was 133 (IQR 50-278). 39% (n=22) had prior eosinophilia and 48% (n=15) had lab findings of sensitivity to food allergens. 66% (n=45) had endoscopic stigmata of EoE. Median eosinophils were 20/hpf (IQR 20-40). 20% (n=8) and 52% (n=15) responded to PPI alone and to topical steroids respectively. 7% (n=5) were treated with dietary exclusion, with 80% (n=4) having a good clinical response (not biopsy proven). 15% (n=10) had histologic remission on a subsequent OGD, with 46% (n=31) undergoing only one endoscopy.
EoE at SJH is increasing in incidence and prevalence, and this accords well with the literature and with prior work by myself at Tallaght University Hospital. There may be an inverse relationship between EoE and helicobacter infection.