Eosinophilic oesophagitis

=EOE, but in the US EE.

In Danish study, incidence tripled between 2011 and 2018…

Boys predominate!  Young kids non specific (aversion, FTT, vomiting), older may have pain, food bolus impaction. 

70% atopic. Besides eosinophils histologically (>15/hpf), “cat scratch furrowing”, exudates, strictures on endoscopy (“trachealization”).

High dose omeprazole 2-3mg/kg (max 80mg) in split doses (before scope, 8/52).  Then Budesonide syrup (nebules broken open, mixed with linctus), nil orally for 30 mins after.  Some reports of adrenal insufficiency with this regimen.

Elemental diet? Usually Milk free effective, else 2-6 food elimination (80% effective – milk, egg, wheat, soya, nuts, fish).  4 weeks at a time. Re-introduce 1 food per 2/52.  Use SPT to guide, as often positive even if not aware of type 1 reactions! 

Most experience in infants is with amino acid formulas, not clear if extensively hydrolysed would be ok or not.

Generally symptoms recur at 5-6/7, if they are going to.   Not practical to repeat endoscopy after each food but symptoms can settle without microscopic remission.  Egg allergy can get worse with exclusion so shorter time or ignore?

[Diana Flynn]

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