Alexander, J.

Summary Background To date there have been no clear features that aid in differentiating patients with eosinophilic oesophagitis (EoE) from PPI ‐responsive oesophageal eosinophilia ( PPI ‐ REE ). However, barium swallow roentgenography is a more sensitive and specific measure to detect subtle fibrostenotic remodeling changes present in EoE. We aim to characterise any clinical, endoscopic, histiological or barium roentgenographic differences between EoE and PPI ‐ REE . Aim To characterise any clinical, endoscopic, histiological or barium roentgenographic differences between EoE and PPI ‐ REE . Methods We performed a retrospective cohort analysis on data collected from a tertiary referral centre population from 2010 to 2015. Data from 66 patients with EoE and 28 patients with PPI ‐ REE were analysed. Cases were adults who met consensus guidelines for EOE , and had a barium swallow study within 6 months of the index endoscopy. Clinical, endoscopic, histiological and barium swallow findings were collected. Results Patients with EoE reported similar characteristics as PPI ‐ REE patients, except EoE patients were younger (35.6 vs. 46.6 years; P = 0.011), had earlier symptom onset (29.0 vs. 38.0 years; P = 0.026), and smaller oesophageal diameters on barium swallow (19.5 mm vs. 20; P = 0.042). Patients with EoE were more likely to have distal strictures (EoE 77% vs. 25%; P = 0.02) and, importantly, a greater likelihood of small calibre oesophagus (51.5% vs. 17.9%; P = 0.002). Moreover, EoE patients had a higher probability of developing small calibre oesophagus after 20 years of symptoms (72.3% vs. 30.2%; P = 0.074) compared to PPI ‐ REE patients. Conclusions When compared with eosinophilic oesophagitis, PPI ‐ REE patients demonstrate findings that suggest PPI‐responsive oesophageal eosinophilia to be a later onset, less aggressive form of oesophageal stricturing disease than eosinophilic oesophagitis.