What are the key clinical features that suggest a diagnosis of eosinophilic oesophagitis in adults?

The key clinical features suggesting a diagnosis of eosinophilic oesophagitis (EoE) in adults include dysphagia, particularly to solids, and episodes of food bolus obstruction. These symptoms often present in young to middle-aged adults and may be chronic or intermittent in nature. Patients frequently report a history of atopic conditions such as asthma, allergic rhinitis, or eczema, reflecting the allergic pathogenesis of EoE. Other symptoms can include retrosternal chest pain, heartburn refractory to proton pump inhibitors, and less commonly, odynophagia. Endoscopic findings supporting the diagnosis often reveal rings, linear furrows, white exudates, and strictures, although these are not always present. Histological confirmation requires eosinophil-predominant inflammation in oesophageal biopsies, typically with ≥15 eosinophils per high-power field. The combination of these clinical features with histological evidence and exclusion of other causes of oesophageal eosinophilia is essential for diagnosis NICE CKS Miehlke 2014Bystrom & O'Shea 2014Miehlke 2015.