Synopsis
Recognise eosinophilic oesophagitis across food impaction and subtle adaptive eating, confirm it with adequate biopsies and combine anti-inflammatory and stricture treatment.
- EoE is a chronic immune-mediated oesophageal disease defined by symptoms of dysfunction and eosinophil-predominant inflammation after competing causes are considered.
- Adults commonly present with intermittent solid-food dysphagia, food impaction or chest discomfort; children may present with feeding difficulty, vomiting or poor growth.
- Patients often adapt by chewing excessively, drinking with every mouthful, avoiding meat or bread and taking much longer to eat, so ask how they eat rather than only whether they swallow.
Key red flags
Meat or bread lodges after a history of intermittent solid-food dysphagia; inability to manage saliva indicates complete obstruction and requires urgent endoscopic care.
Investigation priorities
Assess impaction, inflammatory signs, calibre and focal narrowing.
Management branches
A patient cannot swallow food or saliva after a solid-food impaction.
- Assess airway and aspiration risk, keep nil by mouth and arrange urgent endoscopy; investigate perforation first if severe pain, sepsis or subcutaneous emphysema is present.
- Remove the bolus with appropriate airway support rather than repeated blind pushing or delaying for unproven pharmacological therapy.
Key medicines
Budesonide orodispersible tabletFor adult induction, the licensed dose is 1 mg allowed to dissolve on the tongue twice daily, morning and evening, for six weeks; inadequate responders may continue to twelve weeks under specialist direction.
Proton pump inhibitorA gastroenterologist selects a full-dose licensed PPI regimen, often once or twice daily during induction according to local EoE practice, reflux burden and the current BNF; reassess rather than continuing blindly.