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Eosinophilic oesophagitis J022

Document
Last amended 
17 March 2022
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SOP bulletin on new instrument

SOP Bulletin 229

ICD Coding
  • ICD-10-AM: K20.0
Brief description

This SOP covers a rare, chronic immune disorder of the oesophagus. It involves eosinophil-predominant inflammation of the oesophageal epithelium.  It typically presents with reflux-like symptoms along with chest/upper abdominal pain and difficulty swallowing. There is often a history of atopic comorbidities (e.g., asthma, atopic dermatitis, allergic rhinitis, or immediate food-type allergies).

Confirming the diagnosis

The diagnosis is made from the symptoms, endoscopic appearance, and histological findings. There are other disorders that can cause oesophageal eosinophilia that need to be ruled out (based on the presenting symptoms and specific histological findings).

The relevant medical specialist is a gastroenterologist.

Additional diagnoses covered by SOP
  • Nil
Conditions not covered by SOP
  • Gastro-oesophageal reflux disease / reflux oesophagitis*
  • Oesophageal eosinophilia associated with:
    • connective tissue disorders*
    • Crohn's disease*
    • drug hypersensitivity# 
  • Oesophagitis due to radiation, infectious agents or corrosive agents#
  • Oesophageal varices#

* Another SOP applies

# non-SOP condition

Clinical onset

The condition most commonly affects males in their 20s or 30s, but can occur in childhood or later in life.  Symptoms (particularly difficulty swallowing) have often been present for several years prior to diagnosis.  

An accurate clinical onset may be difficult to establish.  Once the diagnosis has been confirmed and other causes of oesophageal symptoms have been excluded, clinical onset can be backdated to when relevant symptoms first developed.

Clinical worsening

Permanent clinical worsening could be manifest by a persisting increase in the level of symptoms.  The condition is chronic but symptoms may be controlled by treatment.  In some cases the condition will progress to cause oesophageal stricture. 

Management can involve dietary therapy (avoidance of allergens), acid suppression (proton pump inhibitors), topical (swallowed) corticosteroids, and oesophageal dilatation if required.