Eosinophilic Oesophagitis Presenting as Food Impaction in Adulthood: A Narrative Review of Diagnostic Delay and the Treatment Decision
DOI:
https://doi.org/10.5281/zenodo.22237030Keywords:
Eosinophilic Oesophagitis, Food Impaction, Diagnostic Delay, Oesophageal Stricture, DupilumabAbstract
Food impaction is the moment eosinophilic oesophagitis becomes unmistakable, and for most patients it is not the first sign. It is
the point at which years of adapted eating finally fail, and the endoscopy that relieves it is also the opportunity to make the
diagnosis that should have been made earlier.
Objectives: To review the published evidence on eosinophilic oesophagitis presenting as food impaction in adults: how often the
diagnosis is already known, what delay costs in terms of stricture formation, what the treatment options achieve, and what should
happen at the index endoscopy.
Material and Methods: Narrative review of randomised trials, cohort studies, position papers and epidemiological analyses
indexed in PubMed and the major gastroenterology and allergy journals. No new patient data were generated; every estimate
quoted is one published by the original investigators.
Results: In a cohort of 198 oesophageal food impactions, eosinophilic oesophagitis was already diagnosed in only 17.2 per cent.
Reported histologic remission rates are approximately 45 per cent for proton pump inhibitors, 80 to 93 per cent for swallowed
topical corticosteroids, around 60 per cent for dietary elimination and around 60 per cent for dupilumab. In the phase 3 trial,
histologic remission to 6 or fewer eosinophils per high-power field was achieved by 60 per cent on weekly dupilumab against 5
per cent on placebo at 24 weeks. Untreated disease progresses from inflammatory to fibrostenotic, with stricture risk rising by
approximately 5 per cent for each year the diagnosis is not made.
Conclusion: Effective treatments exist and most patients reach remission on one of them, so the determinant of outcome is when
the diagnosis is made rather than which drug follows it. Taking oesophageal biopsies at the index impaction endoscopy,
irrespective of appearances, is the single intervention the evidence most clearly supports.
Abbreviations: DSQ – Dysphagia Symptom Questionnaire, EoE – Eosinophilic Oesophagitis, eos/hpf – Eosinophils per
High-Power Field, EREFS – Endoscopic Reference Score, PPI – Proton Pump Inhibitor, STC – Swallowed Topical
Corticosteroid.
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