P226 Underdiagnosis of eosinophilic oesophagitis in patients with dysphagia in a district general hospital

Introduction Eosinophilic Oesophagitis (EoE) has an annual incidence estimated at up to 20 new cases per 100,000 inhabitants.1 It must be considered in the differential diagnosis of patients with dysphagia or a food bolus. Our previous audits have suggested it is underdiagnosed in our institution. The aim of this study is to evaluate the adherence to European guidelines in the detection of EoE. Methods We retrospectively reviewed the electronic patient records of all patients presenting for an upper gastrointestinal endoscopic procedure with an indication of dysphagia or a finding of food bolus obstruction over 1 year. The study was undertaken in a district general hospital in the south of England. Data was then collected for sex, age, macroscopic findings, quality and location of biopsies as well as histology. This was measured against European guidelines in the diagnosis of EoE, including at least six oesophageal biopsies from different locations and a histological diagnosis documenting 15 eosinophils/hpf in the oesophageal mucosa.1 We applied percentages, means and standard deviations to analyse the data. Results 1 year of endoscopies were reviewed (n=249). 46% of patients were male, the mean age was 68 (range 17–97). At the time of endoscopy only 42.2% of patients had oesophageal biopsies. When we excluded patients with an endoscopic diagnosis of oesophageal malignancy this reduced further to 40.0%. In this group only 9.4% had the recommended six biopsies. The average number of biopsies for each patient was 3.7 (standard deviation 2.5). There were 7 patients with a histological diagnosis of EoE, of whom 6 had a documented eosinophil count of 15 eosinophils/hpf on histology. Conclusions Considering the incidence of EoE, our data suggests that it is very likely underdiagnosed in patients with dysphagia or a finding of food bolus. This may be attributed to lack of awareness of the condition leading to insufficient biopsies and/or the lack of awareness for the number of biopsies required. Our data suggests that histological analysis is largely adhering to guidelines. These practices could be commonplace among trusts nationwide and further work must be done to improve awareness and diagnosis of this treatable condition. This is particularly relevant with the recent addition of an orodispersable budesonide specifically for its management. Reference Lucendo AJ, Molina-Infante J, Arias A, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5(3):335–358. doi:10.1177/2050640616689525