Table 4

Clinical diagnosis, treatment and follow-up of up to 4 years

CasePre-treatment clinical diagnosis (after biopsy)Treatment and follow-up (2009–2011)Final clinical diagnosis
1EOInitial histological response to anti-IL-5 for up to 6 months but then rebound EO warranting treatment with 6 weeks of exclusive elemental feed with good clinical and histological response. Symptoms have now rebound and currently on introduction of dietary protein. Feed aversive behaviour. Atopy.EO
2EOInitial clinical and histological response to egg-, wheat-, banana- and nut-free diet. However, with worsening asthma, his symptoms have re-surfaced, i.e., vomiting and low appetite with some clinical response to leucotriene receptor antagonist.EO
3EOExclusion diet. Gradual improvement of symptoms and at discharged from care at 2 years.EO
4EO + GORD (OS)Clinical improvement in symptoms with long-term PPI and domperidone at 2-year follow-up was gradually being weaned off PPI at 2-year follow-up.GORD (OS)
5EOShort-term PPI and gradually weaned off by 1 year of age.GORD (OS)
6EOSome clinical response to dairy-free diet but then went onto develop feed aversive behaviour and slow transit constipation on follow-up at 2 years. Parents not keen on re-assessment scope as dietary restriction very difficult due to behavioural difficulties.EO
7EO + GORD (OS)Had a gastrostomy. With improvement in nutrition and weight gain, significant improvement in asthma and gastrointestinal symptoms and discharged from care at 2-year follow-up.EO
8EO + GORD (OS)PPI treatment for 6 months with resolution of symptoms.GORD (OS)
9EO +GORD (OS)Initial clinical response to 6-week elemental feed regime and gradual reintroduction of proteins in diet over 3 months. Kept on PPI for 1 year and weaned off by 2nd year. No gastrointestinal or respiratory symptoms at 2-year follow-up.GORD (OS)
10EO + GORD (OS)Stayed on PPI with partial control of symptoms and care then transferred to adult gastroenterologist.GORD (OS)
11EOGiven a trial of PPI with no improvement in symptoms of vomiting, feed aversion and eczema. Then found to have multiple food allergies on RAST testing. At 6 months of age, put on six protein-free diet (milk, soya, egg, nuts, fish and wheat) with complete resolution of symptoms by 9 months. On reintroduction was symptomatic with milk, soya, eggs and wheat but asymptomatic with other nuts and fish. Discharged from gastro follow-up at 14 months.EO
12EOEO identified at the time of gastrostomy insertion along with significant acid reflux. Trial of PPI had some improvement but no resolution. Later Neocate and dairy/soya-free diet with both clinical and histological resolution at 9 months post-diagnosis. She then went into adoption and care was transferred.GORD (OS)
13EO + GORD (OS)Persistence of symptoms despite of topical steroids. At 2-year follow-up, was commenced on oral steroids and had a clinical response to his dysphagia.EO
14EOSubsequently developed eosinophilic gastroenteritis. Excellent response to dairy-free diet on follow-up.Eosinophilic gastroenteritis
15EOInitial poor response to topical budesonide. Subsequently symptomatic improvement on six protein elimination diet.EO
16EOPartial response to PPI but had PEG inserted during the same procedure. After 6-week trial of PPI, went onto Neocate (elemental feed) for 6 weeks. At 18 months dairy and soya reintroduced in diet with tolerance.EO
17EO + GORD (OS)Lost to follow-up.
18EO + GORD (OS)Partial response to PPI alone and then subsequently put on dairy-free diet with clinical improvement in symptoms. Gradually weaned off PPI and at 2 years back onto dairy with no recurrence of symptoms.GORD (OS)
19EOSubsequently developed eosinophilic gastroenteritis. Good response to dairy-, soya- and wheat-free diet.Eosinophilic gastroenteritis
20EOPersistently positive coeliac serology. Re-scoped after 18 months on a gluten-containing diet with no evidence of coeliac disease but persistence of EO. Symptoms of pain did not improve on dairy- or wheat-free diet and was put on topical budesonide with some positive response.EO
21EONo upper gastrointestinal I symptoms after histological diagnosis. Only had intermittent diarrhoea, which was subsequently diagnosed as having irritable bowel syndrome and responded well to Mebeverine and Loperamide.Irritable bowel syndrome
22EO + GORD (OS)Initial lack of response to PPI and anti-histamine but at 2-year follow-up responded to dairy-free diet.EO
23EOImprovement on dairy- and soya-free diet. Symptoms appear to be re-surfacing on reintroduction of soya. Due to a repeat endoscopy.EO
24EONo improvement in symptoms on dairy-free diet and some response to topical budesonide gel. Lost to follow-up.EO
  • EO, eosinophilic oesophagitis; GORD, gastrooesophageal reflux disease; IL-5, interleukin 5; OS, overlap syndrome; PPI, proton pump inhibitor; RAST test, radioallergosorbent test.