Eosinophilic Oesophagitis (EoE)

Diseases of the Digestive System Diseases of Oesophagus

IMPORTANT INFORMATION

The information on the Rare Awareness Rare Education (RARE) Portal is intended for educational purposes only and does not replace professional advice.

Rare diseases typically display a high level of symptom complexity and variability. Individuals diagnosed with the same rare disease may be impacted differently and each person’s experience is unique. Please seek support from qualified healthcare professionals to learn more about the most suitable care and support options for you.

For more information on this disease, please refer to RVA Partner ausEE Inc.,¹ and Australasian Society of Clinical Immunology and Allergy (ASCIA): Eosinophilic Oesophagitis (EoE).²

If you are aware of any additional information that may benefit stakeholders with an interest in this page, or if you notice any broken links or inaccurate information, please let us know via the Contribute page.

Contributors

This page has been co-developed with RVA Partner, ausEE Inc.¹

Emergency Management

There may be special considerations for the emergency management of individuals living with Eosinophilic Oesophagitis (EoE) presenting to emergency departments.

Individuals with EoE may present to emergency departments with food impactions. When treating patients with EoE, it is important to refer to their emergency and management plans:

Clinical Care Guidelines

The following guidelines and recommendations are available regarding clinical care of Eosinophilic Oesophagitis (EoE):

Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis (Proceedings of the AGREE Conference) was developed in 2018 by paediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries, including Australia.
International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature , which involved participation from Australian experts, contains important clarification about the nomenclature of EGIDs for clinical settings
Australasian Society of Clinical Immunology and Allergy resources on EoE:
Australia’s National Allergy Strategy to improve the health and quality of life of Australian with allergic diseases, including conditions such as EoE

Below are guidelines from other countries:

United States: American Gastroenterological Association (AGA) Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis
United Kingdom: British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Synonyms

ICD11: DA24.1

Summary

Eosinophilic Oesophagitis (EoE) is the most well-known type of Eosinophilic Gastrointestinal Disease (EGID).¹ It is an inflammatory condition in which large numbers of eosinophils (a type of white blood cell that is part of the body’s immune system) infiltrate and accumulate in the lining of the food pipe (oesophagus) that connects the mouth to the stomach.^1,2 This may be due to an allergic response to food, environment, or other unknown triggers.

EoE can cause difficulties in feeding or swallowing food, food getting stuck in the oesophagus (food impaction or food bolus obstruction (FOB)), nausea, persistent vomiting, and stomach and chest pain, among other symptoms.^1-3

EoE can affect both children and adults.³ There has been some reported cases of family history with EoE.³ People with EoE may often have other allergic conditions such as asthma, hay fever or eczema.^1-3

Personal stories can be found at ausEE Inc. (EOSaware): My EoE Stories.

Useful Links for Professionals

Human Phenotype Ontology (HPO): Eosinophilic Esophagitis

International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature

ausEE Inc.: Information and Resources for Health Professionals

National Allergy Council: Shared care for allergy

National Allergy Council: Allergy Aware – Resources for Health Professionals

Consortium of Eosinophilic Gastrointestinal Disease Researchers: Resources For Researchers and Clinicians

Symptoms

Symptoms of EoE may present in infants or may arise in older children and adults.² The symptoms vary between individuals, and may include:^1-3

Feeding difficulties (slow chewing of food, needing pureed food, avoidance of certain textures, oral aversion to food)
Poor appetite or not wanting to eat
Difficulty in swallowing food and/or regularly requiring a drink whilst eating
Food getting stuck in the eosophagus when eating, also known as food impaction/Food Bolus Obstruction (FBO)
Nausea, persistent choking or gagging on food, retching, and vomiting/regurgitation of food
Stomach (abdominal) pain or chest pain
Severe acid reflux (heartburn) that does not respond to medications
Failure to thrive/poor weight gain

EoE can also lead to scarring and narrowing of the oesophagus (stricture).^1,2

Please speak to your medical team to learn more about the symptoms and complications of EoE.

Cause/Inheritance

EoE may be caused by an allergy to food or the environment, and in some cases, the exact cause may be unknown.¹ There has been some reported cases of family history with EoE.³

Diagnosis

A diagnosis of eosinophilic oesophagitis (EoE) should be considered in the presence of chronic symptoms of oesophagus dysfunction.³ Diagnosis of EoE usually involves an endoscopy and biopsies performed by a gastroenterologist.^1-3 The endoscopy involves the insertion of an endoscope (a tube with a light and attached camera) to examine the oeosphagus and to take tissue samples (biopsy). The tissue samples are examined by a pathologist to identify if there is accumulation of eosinophils (a type of white blood cell) – the presence of more than 15 eosinophils per high-power field (hpf) is indicative of EoE;^1,3 however other possible causes of increased eosinophils still need to be ruled out.³

The Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis (Proceedings of the AGREE Conference)³ was developed in 2018 by paediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries, including Australia.

Treatment

EoE is a chronic condition that require ongoing management and monitoring supervised by a multidisciplinary medical team.¹Treatment and management of EoE may include dietary changes, medication and endoscopic interventions.^1,2 Regular endoscopies and repeat biopsies may be required to monitor the condition.

Dietary changes should only be made under the direction and supervision of the appropriate medical professional.² This may include elimination diets to identify if EoE is caused by a food allergen or an elemental diet to replace food intake with a liquid formula.^1,2Medications for EoE may include swallowed corticosteroids to reduce inflammation and proton pump inhibitors to reduce acid production as well as for its anti-inflammatory effect; whilst endoscopic interventions such as oesophageal dilation (to widen the oesophagus) may be used in specific cases when the oesophagus is very narrow.^1,2

It is best to speak with your medical team to learn more about the possible treatment for EoE and its associated symptoms. Treatment will depend on an individual’s specific symptoms and complications.

Clinical Care

Healthcare professionals involved in the treatment of EoE may include general practitioners (GP), gastroenterologists (stomach/bowel medical specialists), clinical immunology/allergy specialists and specialist dietitians.² The need for different healthcare professionals may change over a person’s lifetime and extend beyond those listed here.

Research

ausEE Inc.: Research provides information about research on EGIDs in Australia, including funding for medical research grants.

Please visit Australian Clinical Trials to learn more about clinical trials for EGIDs in Australia; there may not be any clinical trials currently available.

Information regarding clinical trials for EGIDs in other countries can be found at ClinicalTrials.gov; there may not be any clinical trials currently available.

For research and clinical trial updates, please visit ausEE Inc. – Clinical Trials.

It is best to discuss your interest in any clinical trials with your medical team to determine suitability and eligibility.

Rare Disease Organisation(s)

ausEE Inc. RVA Partner Australian Organisation

Website: https://ausee.org
Phone: 1300 923 043
Email: [email protected]
Contact form: https://ausee.org/contactus/

ausEE Inc. is Australia’s peak national support and patient advocacy organisation representing Australians living with an eosinophilic disease, with an established focus on eosinophilic gastrointestinal diseases (EGIDs) including eosinophilic oesophagitis (EoE). ausEE’s mission is to improve the lives of those affected by eosinophilic diseases through providing support, evidence-based information, resources, advocacy and by campaigning to raise awareness and funds for research in Australia.

Please note that RVA does not necessarily monitor or endorse each group/organisation’s operational governance.

Please visit the National and State Services pages.

Mental Health

ausEE Inc. offers support programs, including for peer support.

For general mental health resources, please visit the ‘Mental Health’ sections listed on the National and State Services pages.

Other

Further information on EoE, or allergies in general, can be found at:

References

ausEE Inc. Accessed on 9 October 2023. https://ausee.org
Australasian Society of Clinical Immunology and Allergy (ASCIA). Eosinophilic Oesophagitis (EoE) Information for Patients, Consumers and Carers: Frequent Asked Questions. 2021. 3p. Available from: https://allergy.org.au/images/pcc/ASCIA_PCC_EoE_FAQ_2021.pdf
Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterol. 2018;155:1022-1033. https://doi.org/10.1053/j.gastro.2018.07.009

Page Last Updated

30/10/2023 09:43

Diseases of the Digestive System Diseases of Oesophagus