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Eosinophilic Oesophagitis — RACP Adult Medicine MCQ

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HardGastroenterologyEosinophilic OesophagitisRACP Adult Medicine

A 28-year-old with atopy has recurrent solid-food impaction. Endoscopy shows rings and furrows, and oesophageal biopsies contain at least 15 eosinophils per high-power field. What is an appropriate disease-directed treatment?

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Correct answer: E — Use swallowed topical corticosteroid, proton-pump inhibitor or elimination diet, adding dilation for fixed narrowing

The best answer is “Use swallowed topical corticosteroid, proton-pump inhibitor or elimination diet, adding dilation for fixed narrowing”. The clinical, endoscopic and histological features support eosinophilic oesophagitis. Effective first-line anti-inflammatory choices include PPI, swallowed topical steroid and an empiric elimination diet; response is assessed clinically and histologically. Dilation treats a fixed stricture but not the inflammation. Asthma inhalers, antibiotics and permanent dietary avoidance without treatment do not control oesophageal disease.

Reference: Gastroenterological Society of Australia: Clinical practice resources: https://gesa.org.au/Web/Resources/Clinical_Practice_Resources.aspx