PTH-182 Atopic history and ige levels – are they a useful adjunct in diagnosing eosinophilic oesophagitis? – a study of investigations and treatment response in the adult population of a district general hospital: Abstract PTH-182 Table 1

Abstract

<h3>Introduction</h3> Eosinophilic Oesophagitis (EoE) is an increasingly common cause of dysphagia. Most reported series are from specialist centres. We present a series of adult patients with EoE from a typical UK district general hospital, describing their demographics, investigations and treatment response. We also highlight the role of Total IgE measurement in supporting the diagnosis. <h3>Method</h3> Patients were selected retrospectively by reviewing biopsies from endoscopies performed over a 4 year period (2009–2012). Diagnosis of EoE was confirmed by having oesophageal symptoms, 15 or more eosinophils per high powered field and absence of an alternative diagnosis. <h3>Results</h3> 73 cases were identified, 52 were male and 21 female. Average age at presentation was 51 years. Presenting symptoms included dysphagia (n = 58), bolus obstruction (n = 34) and reflux (n = 19). We estimate EoE is responsible for 3% of cases of dysphagia presenting to our hospital. 49 patients were asked about atopy history. 37 (76%) had a positive history for at least one condition; hay fever (n = 19), asthma (n = 18), eczema (n = 8), urticarial (n = 4) and/or dermatitis (n = 1). Total IgE was measured in 31/65 (48%) patients who had blood tests. 30 (97%) had either a strongly positive (n = 27) or positive (n = 3) total IgE reading, defined as total IgE &gt; 0.35 kU/L. Levels ranged from 5–520 kU/L. 23/31 (74%) of these cases had history of atopy. Food mix allergy testing was done in 29/73 with a positive result in 16. First line treatments prescribed were documented in 62 cases as shown: Those not responsive to combination therapy of PPI and swallowed steroid as first line agents had antihistamines, domperidone or cromoglycate added. <h3>Conclusion</h3> EoE is a common and treatable cause of dysphagia. This study supports that adult EoE patients have atopic coexistence, more often reported in paediatric studies. Total IgE measurement may be useful in supporting a diagnosis. Only 3 previous studies have reported total IgE levels in EoE patients. Food specific radioallergosorbent testing (RAST) may have a role in management of EoE with dietary exclusion a treatment option. This is well described in the paediatric population but less so in adults – only one adult study has described use of food specific RAST in adult EoE patients. Given the variability in treatment approach to EoE there is a clear need for guidelines to standardise the care of EoE. <h3>Disclosure of interest</h3> None Declared.