Evaluating the Management of Eosinophilic Oesophagitis in a Specialist Clinic: A Real-World Financial Analysis and Proposed New Management Algorithm

Background Eosinophilic oesophagitis (EoE) is an increasingly recognised chronic condition characterised by dysphagia and recurrent food bolus obstruction (FBO), often requiring emergency endoscopic dilation. Managing EoE imposes significant financial burdens on gastroenterology departments, including costs associated with diagnostic endoscopies, elective dilations, remission monitoring and emergency procedures. EoE substantially impacts patients’ quality of life, often instilling a pervasive fear of eating and drinking, especially when remission is not achieved. Methods This retrospective observational study analysed longitudinal records of 93 patients with EoE treated at a specialist clinic (May 2020–April 2024). We assessed demographics, clinical presentations, diagnostic records, treatment modalities, adverse events and histological remission outcomes. Based on real-world clinical data and published remission rates, we proposed a new management algorithm: Results 65.6% (n = 61) of patients were male and 75.2% (n = 70) had a significant atopic background. ODB was the most common treatment (44.1%), followed by PPI (38.7%), FED (4.3%) and other treatments (12.9%). Post-treatment, 58.1% of patients underwent re-endoscopy for histological remission. The mean interval between diagnostic and surveillance endoscopies was 71.0 weeks (SD:100.6), far exceeding the recommended 8–12 weeks. Histological remission rates were 66.7% for ODB, 30.0% for PPI and 50.0% for FED. Financial analyses assessing cost efficiency and resource utilisation suggest that ODB treatment is marginally cheaper per patient than PPI-based approaches, while achieving improved histological remission rates. Conclusion This study identifies challenges in managing EoE within current healthcare systems, including low patient concordance to invasive endoscopy protocols and long waiting lists for procedures. Findings revealed suboptimal adherence to national guidelines and low remission rates across treatment modalities compared to published outcomes. The financial analysis suggests re-evaluating management by balancing surveillance endoscopy needs in ODB-treated patients with evidence-based remission rates while considering additional costs from recurrent adverse events associated with low-remission treatments. Optimising treatment strategies and endoscopies could enhance clinical and histological remission while improving cost-efficiency and healthcare capacity, contributing to provide a more sustainable approach in managing EoE.