Improving management of eosinophilic oesophagitis in adults in the UK: proposal for an integrated care pathway

Abstract

Eosinophilic oesophagitis (EoE) is a chronic condition characterised by solid-food dysphagia and food bolus obstruction due to T-helper cell-driven eosinophilic infiltration of the oesophageal epithelium and submucosal fibrosis. Suboptimal management results in delayed diagnosis, repeated food bolus obstructions and hospital attendances, inappropriate referral and treatment, increased healthcare resource use, and impaired quality of life. A group of clinicians with an interest in EoE deliberated on the current care pathways and evidence of best practice to develop an integrated care pathway to optimise the diagnosis and management of EoE. Key recommendations include suspecting EoE in patients presenting with food bolus obstruction or dysphagia; referring to gastroenterology and for oesophago-gastro-duodenoscopy promptly; taking at least six biopsies from multiple sites (ideally three) to diagnose EoE based on >15 eosinophils/0.3 mm2 oesophageal epithelium; using budesonide orodispersible tablets, as the only UK-licensed therapy for EoE for induction of remission and maintenance; arranging regular oesophago-gastro-duodenoscopies, gastroenterology follow-up and maintenance therapy due to the high relapse rate; and involving primary care to manage follow-on prescribing.