Physician's Assistant

Refined clinic letter Tue 08 July 2025 10:01

Last Modified: 272 days ago

MRN:

Content:

Diagnosis:
Eosinophilic oesophagitis - June 2025

Other Medical Diagnoses:
• Chronic fatigue syndrome - 2002
• Migraine - March 2013
• Laparoscopic subtotal hysterectomy - April 2013 (for menorrhagia)
• Ruptured breast implant - October 2013
• Abdominal pain - February 2020
• Dysphagia - May 2025

Current Medications:
• Oestrogel Pump-Pack 0.06% gel - Apply 2 pumps daily
• Omeprazole 20mg PO OD - current dose
• Budesonide orodispersible (Jorvisa) - STARTED TODAY
• Omeprazole 40mg PO BD - DOSE CHANGED FROM 20mg OD

Investigations:
• OGD (May 2025): Early trachealization of mucosa mainly in upper oesophagus with patchy erythema in mid-oesophagus. G&J at 40cm slightly narrow but scope passed easily. Multiple linear erosions of antrum
• Histology from antrum: Chemical/reactive gastropathy, no evidence of active inflammation or H. pylori
• Oesophageal biopsies: Mild chronic inflammatory infiltrate with lymphocytes and eosinophils throughout, eosinophils >15 per hpf consistent with eosinophilic oesophagitis
• Colonoscopy (2023): Normal colonoscopically, challenging procedure due to tender sigmoid looping
• CT abdomen and pelvis (2023): No cause for abdominal pain apart from moderate faecal loading
• Anorectal manometry (2023): Normal

Management Plan:
1. Commence budesonide orodispersible (Jorveza) course for 8 weeks
2. Increase omeprazole to 40mg BD
3. Trial elimination of soy from diet during steroid course
4. Upper GI endoscopy in 8 weeks to assess histological improvement
5. Gastroenterology clinic review in 12 weeks with histology results
6. Consider immunology referral for throat swelling symptoms

I had the pleasure of speaking on the telephone to Mrs Helen Foale on behalf of Professor Lewis in gastroenterology clinic today.

I'm sorry to hear she's been struggling with her health recently. She's been experiencing multiple episodes over the last few months of her throat swelling up and having difficulty in swallowing. This culminated in a single episode of likely food bolus obstruction where she attended hospital but this resolved spontaneously without the need for endoscopic intervention. At this time she had absolute dysphagia and was unable to swallow her own saliva.

A recent endoscopy has shown early trachealization and the possibility of a slight stricture at the GOJ, however this did permit the gastroscope and biopsies have demonstrated signs consistent with eosinophilic oesophagitis.

She describes an uncomfortable sensation in her oesophagus and in the back of her mouth which she predominantly associates with any food but can be more associated with soy. She's reassuringly not had any weight loss.

Also note she's been investigated back in 2023 for right iliac fossa pain with a colonoscopy which was challenging due to tender sigmoid looping however was normal colonoscopically, a CT scan of her abdomen and pelvis which did not show any cause for abdominal pain apart from moderate faecal loading, and anorectal manometry which was normal.

We've today discussed the diagnosis of eosinophilic oesophagitis, the association with various food groups and that dietary elimination of food groups that trigger the symptoms can be very beneficial when maintaining remission.

She's tried a course of PPI admittedly at a low dose since at least the time of her upper GI endoscopy and not found this to be effective.

We discussed today that I'd usually suggest increasing these PPIs to 40mg BD, however her symptoms are quite significant and she's really struggling with them and so I'll prescribe her a course of orodispersible budesonide (Jorvisa) which I hope will improve her symptoms.

I've booked her another upper GI endoscopy in 8 weeks time following this course of Jorvisa in order to assess whether there's any histological improvement and then a clinic appointment in 12 weeks time to tie up all the results together and discuss about how we're going to maintain remission in the eosinophilic oesophagitis.

Yours sincerely

Field Clipboard (for EPR paste)

Builds copy buttons from the headings currently in the note, and also lets you copy the entire note.

Summary:

Investigations:

Refined clinic letter Tue 08 July 2025 10:01

Field Clipboard (for EPR paste)

Tasks

Feedback