Eosinophilic oesophagitis
Dysphagia and food bolus obstruction in a young atopic man, the 15 eosinophils per high-power field threshold, why biopsy beats symptoms for monitoring, PPI, orodispersible budesonide (PBS), empirical diets, dupilumab and dilation, and food bolus management.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A chronic type 2 (Th2) immune disease of the oesophagus: eosinophilic inflammation driven mainly by food antigens, leading over years to fibrosis and strictures.
- The classic patient is a young man with atopy (asthma, eczema, hay fever) who eats slowly, chews carefully and presents with dysphagia or food bolus obstruction. Male to female ratio is about 3:1.
- Diagnosis needs symptoms plus 15 or more eosinophils per high-power field on biopsy, with other causes excluded.
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Sources
- Perananthan V, Burgell R. Diagnosis and management of eosinophilic oesophagitis. Aust Prescr 2024;47(1):20-25AU/NZAustralian Prescriber (Therapeutic Guidelines), 2024
- PBS Schedule: budesonide orally disintegrating tablets for eosinophilic oesophagitis (initial, first continuing and subsequent continuing restrictions)AU/NZAustralian Government Department of Health, Disability and Ageing, 1 November 2026 Schedule (PBS API, accessed 13 November 2026)
- ASCIA patient information on eosinophilic oesophagitisAU/NZAustralasian Society of Clinical Immunology and Allergy (ASCIA), updated September 2025
- Dellon ES et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol 2025;120(1):31-59American College of Gastroenterology, 2025
- Dellon ES et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology 2018;155:1022-1033Gastroenterology, 2018
- Straumann A et al. Budesonide orodispersible tablets maintain remission in a randomized, placebo-controlled trial of patients with eosinophilic esophagitis (EOS-2). Gastroenterology 2020;159:1672-1685Gastroenterology, 2020
- Dellon ES et al. Dupilumab in adults and adolescents with eosinophilic esophagitis. N Engl J Med 2022;387:2317-2330New England Journal of Medicine, 2022
- Kliewer KL et al. One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol 2023;8:408-421The Lancet Gastroenterology and Hepatology, 2023
- Last updated
- 14 November 2026
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