Dietary intervention is effective for the management of eosinophilic oesophagitis (EoE) in both adults and children. 1 The majority of research has been conducted in Spain or the United States, 1 with no studies of dietary intervention published in the United Kingdom. Restrictive elimination diets can be challenging and swallowed topical corticosteroids have also been shown to be an effective treatment in adults. 2 Despite their efficacy, disadvantages include risk of candidiasis, 3 potential long-term effects such as adrenal suppression 3 and off-label medication use. Proton pump inhibitors (PPIs) are effective for a proportion of patients 4 although with both PPIs and corticosteroids, the underlying triggers of this presumed antigen-mediated condition are not identified and continued use is required to maintain efficacy. 3 A key aspect in the management of any allergic disease is avoidance of relevant allergens. Through a multidisciplinary collaboration between Adult Allergy, Gastroenterology, and Dietetics, we launched a service to provide dietary intervention for adults with EoE in a UK tertiary referral centre. We recently undertook a retrospective evaluation with the aim to describe the clinical phenotype of EoE in our service and to determine the clinico-pathological response to dietary or medical interventions in this cohort (GSTT service evaluation 6195). | ME TH ODSA search of the histology reporting system was performed in patients who had oesophageal biopsies taken over 2 years using the term "eosinophil". Patients were also identified by reviewing clinical records. The resulting list was manually screened for eligible patients, namely adults (>16 years) with an oesophageal eosinophil count over 15 per high power field (hpf) and documented history of suggestive symptoms.In our pathway (Figure 1), all patients with oesophageal eosinophilia were advised to start a PPI as per previous guidelines. 5 Both responsive and non-responsive patients were offered a choice between dietary management, corticosteroids or long-term PPI if responsive. Prior to dietary intervention, patients were assessed by both an Allergist and specialist allergy dietitian. They underwent extensive allergy testing using skin prick and serum specific IgE tests and were placed on a test-directed exclusion diet if any results were positive (unless solely sensitised to tree nuts). If no target foods were identified through testing, patients were recommended to undergo the six-food elimination diet (SFED), followed by sequential food reintroduction to identify triggers. A further biopsy was taken after 6 weeks of intervention. If the SFED was not successful, steroids or an elemental diet was recommended.Eosinophil counts and histological response were compared in those who had both pre-and post-treatment endoscopies for PPIs, steroids, and dietary interventions. All were undertaken for a minimum of 6 weeks for diet and 8 weeks for PPI and corticosteroids.Complete histological response was defined as an eosinophil count of less than 5 cell...

IntroductionManagement of eosinophilic oesophagitis (EoE) includes proton pump inhibitors (PPIs), topical steroids, or dietary intervention. In adults dietary management commonly consists of either the six-food elimination diet (SFED) or allergy-test directed food exclusion. To date patient characteristics and outcomes from various interventions have not been reported in a UK population.MethodA retrospective evaluation of adults (≥16 years) with oesophageal eosinophilia (≥15 eos/hpf) over a two-year period was undertaken. Patients were identified from histology reports and clinical records. Treatment episodes were analysed in those who had both pre- and post-intervention biopsies. Patients who underwent dietary interventions were advised by a specialist dietitian.ResultsOur search identified 100 subjects 18–84 years of age (median 35) with a predominance of males (76%; 76/100) and Caucasians (94%; 67/71). Atopic conditions were reported in 75% (65/87) and allergy testing with skin prick or specific IgE tests was positive to food allergens for 71% (44/62) and aeroallergens 72% (38/53). PPIs were given first-line for 75% (38/51) and overall 22% fully responded to a PPI (5/23). Fifty-one patients had both biopsies covering 73 treatment episodes (table 1). Signficant reductions in eosinophil counts were seen for SFED and allergy-test directed diets. There were no significant differences in efficacy between treatment groups.Abstract OC-041 Table 1 Median peak eosinophil count InterventionResponders (%)*PrePostp value** PPI8/23 (35)44300.230Steroids5/12 (42)53150.117SFED13/23 (65)47100.006Test-directed5/10 (50)62230.036Other empiric diet1/6 (17)55580.437Elemental diet2/2 (100)331n/a*<15 eso/hpf or ≥50% reduction in peak count. **Wilcoxen signed rank testThrough food reintroduction and biopsies 14 patients identified dietary triggers: 57% milk (n=8), 29% gluten containing cereals (n=4), 14% egg (n=2), 7% soya, nuts, shellfish or fruit (each n=1). For those who completed the process (n=10), 50% had only one trigger, 30% two, and 20% three or more.ConclusionBaseline characteristics were comparable to other described cohorts with a high proportion of males, Caucasians and a high rate of atopy. Dietary intervention particularly with the SFED appears to be effective in our population, with a non-significant trend to higher response rates compared to other interventions. Since the most common triggers were dairy and cereals, empirical exclusion of these two food groups may be an effective approach.Disclosure of InterestNone Declared