Oesophageal Diseases

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Question 1
A 34 year old male has had repeated bouts of food impaction, and today he presents with the same. He has a past medical history of atopic illnesses. He undergoes an endoscopy with the results shown below:
Picture
Which of the following is the most appropriate treatment strategy?

(A) Omalizumab
(B) Antigen de-sensitisation
(C) Gluten free diet
(D) Esophageal dilatation
(E) Topical steroids such as fluticasone with concomitant 6 food elimination diet

E: Topical steroids with 6 food elimination diet would be the treatment of choice. This picture shows the typical macroscopic features of eosinophilic oesophagitis, which is an increasingly recognised entity. Histology would reveal the presence of eosinophils (>15 per hfu) in a mucosa otherwise devoid of this cell lineage. Omalizumab is an anti-IgE monoclonal antibody and has no effect on the disease course of eosinophilic oesophagitis. The pathogenesis relates to chronic antigen exposure, perhaps through increased leakiness of tight junctions in the squamous epithelium of the oesophagus. Eosinophils are recruited, driven largely by a Th2 response and secretion of IL-13. In addition, IL-13 has been shown to decrease the synthesis of tight junction molecules such as desmoglein. Corticosteroids decrease IL-13 secretion and hence are effective in this condition. Treatment is long term as the pathogenesis is chronic. N Engl J Med 2015; 373:1640-1648
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  • About
  • Written
    • Respiratory Medicine
    • Medical Oncology >
      • Colorectal Cancer
      • Lung Cancer
      • Urogenital Cancers
      • Emergencies
      • Melanoma
      • Breast
    • Haematology >
      • Anaemia
      • Coagulation
      • Malignancy
    • Cardiology >
      • General Cardiology
      • Coronary Artery Disease
      • Heart Failure
      • Valvular Heart Disease
      • Arrhythmia
    • Endocrinology >
      • General Endocrinology
      • Reproduction
      • Pituitary
      • Diabetes
    • Clinical Immunology
    • Clinical Toxicology
    • Genetics
    • Geriatrics
    • General Medicine
    • Statistics
    • Gastroenterology >
      • Pancreas
      • Inflammatory Bowel Disease
      • Oesophageal Diseases
      • Stomach and Small Intestine
      • Liver
    • Infectious Diseases >
      • Viruses
      • Bacteria
      • Parasites
      • Fungus
    • Neurology >
      • Anatomy
      • Nystagmus
      • Myopathies
      • Stroke
      • Neurodegenerative Disorders
      • Neuropathy
    • Nephrology >
      • Glomerulonephritis
      • General Nephrology
      • Chronic Kidney Disease
    • Psychiatry
    • Palliative Care
    • Pharmacology
    • Rheumatology >
      • Rheumatoid Arthritis
      • Connective Tissue Diseases
      • Spondyloarthropathies
      • Crystal Arthropathy
  • Clinical
    • Short Cases >
      • Haematology
      • Endocrine
      • Neurology
      • Rheumatology
      • Renal
      • Gastroenterology
      • Cardiology
      • Respiratory
    • Long Cases >
      • Addiction & Psychiatry
      • Cardiology
      • Endocrinology
      • Geriatrics
      • Gastroenterology
      • Renal
      • Haematology
      • Infectious Diseases
      • Oncology
      • Rheumatology
      • Respiratory
      • Neurology
      • Set pieces
  • Medical Students
  • Respiratory
    • Asthma >
      • Acute Exacerbation
    • COPD >
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    • Lung Cancer >
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