EOE

What's Eosinophilic esophagitis (EoE) ?

It is a chronic immune-mediated disorder of the esophagus characterized by clinical symptoms of esophageal dysfunction and the histologic presence of more than or equal to 15 eosinophils per high-powered field in the esophageal mucosa, in the absence of other eosinophilic syndromes.

What is the Prevalence of EoE in children ?

• The Prevalence of disease is high ( 63% to 88% ) worldwide .

• The exact prevalence is not known in Saudi Arabia.

• There was a clear rising trend seen in Saudi children over years which is more common in male gender .

What is the Prevalence of EOE in Children ?

• It is more commonly seen in patients with atopic diseases such as food allergy, asthma, and allergic rhinitis

• The overall risk for first-degree relatives of a patient with EoE is 1.8%, increasing to 2.3% for sex-matched first-degree relatives.

Pathophysiology of EoE

- A gene locus was identified at chromosome 5q22 with the identification of the gene TSLP

(thymic stromal lymphopoietin protein).

Indications of Referal

- Patients who have dysphagia, food impaction, reflux symptoms unresponsive to PPI.

- Longstanding reflux symptoms.

- Inability to withdraw PPI therapy without recurrence of symptoms.

Diagnosis of EoE

Endoscopic visual clues to diagnosis :

linear furrows, concentric rings, loss of the typical esophageal vascular pattern, and/or the presence of white patches on the mucosal surface.

Diagnosis of EoE

• A normal esophagus at endoscopy does not exclude the diagnosis of EOE.

• It is recommended that at least 2 to 4 biopsies should be taken from both the proximal and distal esophagus, regardless of the endoscopic appearance of the esophagus

Diagnosis of EoE

Additional histopathological findings favoring EoE include basal cell hyperplasia, lamina propria fibrosis with elongation, eosinophil microabscesses, eosinophil degranulation, ulceration, and intercellular edema

Diagnosis of EoE

Treatments of EoE

The goal of the treatment should ideally be both the resolution of symptoms and the normalization of the macroscopic and microscopic abnormalities.

Treatments of EoE

Dietary Aspects of EoE Treatment

• Use of an amino acid–based elemental diet.

• Use of 6-food elimination diet empirically.

• Selective elimination of specific foods based on results of allergy testing and clinical symptoms.

Pharmacological Treatment of EoE

To date, only 2 steroid preparations, swallowed fluticasone propionate (FP) and oral viscous budesonide (OVB), have been shown to have a therapeutic benefit in EoE.

Pharmacological Treatment of EOE

OBV

1 mg daily for children younger than 10 years

2 mg daily for older children and adults

split into 2 divided doses

88 to 440 mg 2 to 4 times daily for children

440 to 880 mg twice daily for adolescents/ adults

Other Treatments of EOE

How are patients monitored ?

• Routine office follow-up visits are required to monitor the symptoms .

• An endoscopy and biopsy should also be performed when medication or diet is instituted or changed in order to determine its efficacy.

• if symptoms worsen or if patients are not on any therapy, an endoscopy with biopsy should be performed every few years.