Gastroenterology · London
Eosinophilic oesophagitis (EoE) - private in London.
A specialist EoE pathway - gastroscopy and 6+ biopsies for diagnosis, then a joint plan across PPI, budesonide orodispersible, six-food elimination diet or dupilumab, with re-scope to confirm remission. Adult and paediatric clinics.
Why patients choose us
- 01
A named EoE gastroenterologist, not a general list
A consultant with a specialist interest in oesophageal disease, working alongside allergy and dietetics - not a routine reflux clinic slot.
- 02
Diagnosis done properly, first time
A gastroscopy with 6+ biopsies from proximal, mid and distal oesophagus, EREFS scoring, and a PPI-responsive check before we call it EoE.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
What EoE is
A chronic, immune-mediated oesophageal disease.
Not reflux, and not an allergy in the classic sense - a Th2 inflammatory disease that lives in the wall of the oesophagus.
Th2 immune-mediated inflammation
EoE is a chronic, Th2 immune-mediated disease of the oesophagus, driven by IL-4, IL-5 and IL-13. Food antigens and aeroallergens trigger a local eosinophilic response in the oesophageal mucosa.
Symptoms of oesophageal dysfunction
Adults present with dysphagia, food impaction and non-cardiac chest pain. Children with feeding difficulties, vomiting, failure to thrive and abdominal pain. Symptoms are often normalised for years before diagnosis.
≥15 eosinophils per high-power field
Diagnosis needs a peak count of at least 15 eosinophils per high-power field on oesophageal biopsy, plus exclusion of other causes of oesophageal eosinophilia. It cannot be diagnosed on symptoms alone, and it cannot be diagnosed without biopsies.
Cost in London
What private EoE care costs in London.
Indicative ranges across our London network. Tell us where you are in the pathway and we quote firm figures for the next step.
In short
Diagnostic gastroscopy with biopsies in London: £1,800-£2,800, home the same day.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant gastroenterology review | £280-£420 | 30-45 min | Same visit |
| Gastroscopy + 6-8 oesophageal biopsies | £1,800-£2,800 | 15-25 min | Histology 7-10 days |
| Budesonide orodispersible (Jorveza) 1 mg BD | £180-£280 / month | 6 wk induction | Re-scope at 8-12 wk |
| Dupilumab (Dupixent) 300 mg weekly SC | £1,200-£1,600 / month | Ongoing | Response at 12-24 wk |
| Six-food elimination diet, dietitian-led | £1,400-£2,400 | 6 wk elimination + re-intro | 6-12 months |
| Endoscopic dilation for symptomatic stricture | £3,500-£5,500 | 20-30 min | Same visit |
| Component-resolved allergy testing (ISAC / ALEX) | £450-£650 | 15 min blood | 7-10 days |
| Second-opinion review of prior scope and histology | £250-£450 | 30 min | 48 hours |
Prices vary by hospital, by which consultant runs the clinic, and by whether the biologic is delivered through the hospital pharmacy or a homecare provider. Insurance covers most of this pathway when medically indicated - we check cover in writing before booking.
Diagnosis
Gastroscopy with six or more oesophageal biopsies.
The diagnosis is histological - the endoscopy alone can suggest EoE but only biopsies can confirm it.
-
EREFS scoring at endoscopy
Photographs and scoring of edema, rings (trachealisation), exudates (white plaques), furrows and strictures. Around 10-15% of confirmed EoE has an endoscopically normal-looking oesophagus - which is why biopsies are non-negotiable.
-
6+ biopsies across three levels
At least 2 biopsies each from proximal, mid and distal oesophagus. Peak count of ≥15 eosinophils per high-power field on the worst biopsy is the diagnostic threshold. Basal cell hyperplasia and microabscesses support the diagnosis.
-
Exclude other eosinophilia
GORD-responsive oesophagitis, achalasia, Crohn’s and drug reactions can all raise eosinophils. A high-dose PPI trial (or documented failure of PPI) is now built into the diagnostic pathway, not a separate step.
-
Allergy work-up (optional)
Skin-prick and patch testing, or component-resolved allergy testing (ISAC / ALEX), can be useful in children and in adults planning targeted elimination diets - but does not replace the empiric six-food or 2-4-6 diet in adults.
-
Paediatric considerations
Children under general anaesthetic; biopsies from the same three levels; growth and nutrition assessment; paediatric dietetics from day one.
-
Re-scope at 8 to 12 weeks
Whichever treatment you start, a repeat gastroscopy with repeat biopsies at 8 to 12 weeks confirms whether the eosinophil count has dropped below 15/hpf. Symptoms alone are not a reliable marker of remission.
The journey
From first symptoms to remission - what happens, in order.
One team from first message to maintenance - including the histology, the treatment choice and the follow-up scope.
Phase 1 · Before your gastroscopy
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us your symptoms or scope report
A short, confidential form. Dysphagia, food impaction history, prior PPI trial, any biopsies already taken.
- 02
Before
We come back with a recommendation
Within one working day: whether a diagnostic gastroscopy is needed, or which second-opinion pathway fits. Indicative price. Insurance guidance.
- 03
Before
We arrange the gastroscopy and biopsies
Usually within one to two weeks. Fasting instructions and sedation options sent. Allergy testing arranged in parallel if relevant.
- 04
On the day
Arrival at the unit
Consent, a chat with the endoscopist, sedation with midazolam and fentanyl, or throat spray if you prefer to stay awake.
- 05
On the day
Gastroscopy with EREFS and 6+ biopsies
15 to 25 minutes. Photographs of furrows, rings, exudates, oedema and strictures. Biopsies from proximal, mid and distal oesophagus.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a couple of hours. Someone to collect you if you had sedation.
- 07
After
Histology and a treatment plan
Histology in 7 to 10 days. If ≥15 eos/hpf, a joint plan: PPI, budesonide orodispersible, six-food elimination or dupilumab. Re-scope at 8 to 12 weeks.
Typical end-to-end: 1-2 weeks to gastroscopy. Histology: 7-10 days. Re-scope to confirm remission: 8-12 weeks.
Symptoms
The patterns we see, in adults and children.
If you have quietly adapted your eating over years - small bites, lots of water, no steak or dry bread - this is the section to read.
-
Recurrent food bolus impaction
Meat, bread or dry food that lodges in the oesophagus and needs to be waited out, brought back, or removed endoscopically.
-
Adult dysphagia with normal reflux
Slow eating, extensive chewing, avoidance of steak, chicken and bread - despite a normal PPI trial for reflux.
-
Chest pain, heartburn refractory to PPI
Non-cardiac chest pain and heartburn that has not settled on 8 weeks of high-dose PPI - a classic EoE presentation.
-
Children: feeding refusal, vomiting
Younger children with feeding difficulties, vomiting, poor growth or abdominal pain - often mislabelled as reflux or fussy eating.
-
Known atopy: asthma, eczema, hay fever
A personal or family history of atopic disease makes EoE more likely - it sits on the same Th2 spectrum.
-
Endoscopic furrows, rings, white plaques
Vertical furrows, trachealisation (rings), white exudates or narrowing seen on a prior scope - all EREFS features of EoE.
-
Failed response to a PPI trial
8 weeks of high-dose omeprazole 40 mg BD without endoscopic and histological remission - time for topical steroid, diet or dupilumab.
-
Red flag: complete bolus obstruction
A food bolus that will not pass, with hypersalivation and inability to swallow saliva, needs urgent endoscopy, not a private outpatient booking.
Treatment options
First-line, second-line and endoscopic options.
PPI, budesonide orodispersible or six-food elimination sit alongside each other as first-line. Dupilumab is reserved for refractory disease. Dilation is for symptomatic strictures only.
-
High-dose PPI trial
Omeprazole 40 mg twice daily for 8 weeks, then re-scope and re-biopsy. Around 40-50% of adults respond histologically - simple, cheap, first line.
-
Budesonide orodispersible (Jorveza)
A licensed topical corticosteroid tablet that dissolves on the tongue and coats the oesophagus. 1 mg twice daily for 6 weeks, then 0.5-1 mg daily maintenance.
-
Swallowed fluticasone (off-label)
A metered-dose inhaler puffed into the mouth and swallowed - cheaper than Jorveza but off-label, with more variable dosing.
-
Six-food elimination diet (SFED)
Milk, egg, wheat, soya, fish and shellfish, and tree nuts and peanuts excluded for 6 weeks, then re-introduced one food group at a time with re-biopsy. Effective, demanding.
-
Step-up 2-4-6 elimination
Start with milk and wheat (2), step up to 4 then 6 if needed - identifies the trigger in most patients with fewer re-scopes than classic SFED.
-
Dupilumab (Dupixent)
An anti-IL-4Rα biologic, 300 mg weekly SC. EMA and NICE (TA898) approved for age ≥12 with refractory EoE. Significant EREFS and histological improvement in trials.
-
Endoscopic dilation
Pneumatic balloon or bougie dilation for symptomatic strictures. Symptom relief within weeks. Does not treat inflammation - always combined with medical therapy.
-
Second-opinion review
A specialist review of your scope report, biopsies and allergy panel - sometimes the answer is a different diagnosis, not more treatment.
Where in London
The London hospitals we work with for EoE.
A short panel of London consultant EoE clinics - adult and paediatric. Introductions are made privately, once we understand your case.
Selection criteria
How we choose the London EoE consultants we recommend.
-
University College London Hospital Private - academic EoE and dysphagia service
-
Royal Free Private - consultant gastroenterology with allergy and dietetics
-
HCA London Bridge Hospital - adult EoE and therapeutic endoscopy
-
The London Clinic - Harley Street gastroenterology and biologics access
-
Great Ormond Street Hospital International Private - paediatric EoE clinic
-
Cromwell Bupa Hospital - gastroenterology with paediatric pathways
Safety and recovery
What to expect - honestly.
Diagnostic gastroscopy is a common, safe procedure. Long-term EoE care is about the treatment you choose, the side effects you tolerate, and the re-scope you need to prove remission.
-
Sedation with midazolam and fentanyl
Standard gastroscopy sedation. Throat spray alone is an option for shorter, diagnostic scopes if you prefer to stay awake.
-
Biopsies do not hurt
Oesophageal biopsies with forceps cause no pain and heal within hours. Minor sore throat for a day is common.
-
Budesonide side effects
Oral candidiasis (thrush) is the commonest side effect of Jorveza - around 5-10%. Rinsing the mouth after use and not eating or drinking for 30 minutes reduces risk.
-
Dupilumab side effects
Injection-site reactions, conjunctivitis and occasional arthralgia. Rare eosinophilia elsewhere. Reviewed at 12 and 24 weeks.
-
Dilation - perforation risk
Around 0.3% in experienced hands. Chest pain lasting more than 24 hours after dilation needs same-day contact and imaging.
-
Elimination diet is demanding
Weekly dietitian contact and careful reading of every label. A structured re-introduction phase with re-biopsy is essential - without it, you cannot identify the trigger.
-
Long-term maintenance
EoE is chronic. Stopping treatment usually means relapse within months. A long-term plan - lowest effective dose - is agreed at diagnosis.
-
Growth and nutrition in children
Paediatric EoE needs paediatric gastroenterology and paediatric dietetics from day one - growth, nutrition and feeding behaviour all matter.
-
Red flags after discharge
Complete inability to swallow saliva, worsening chest pain, fever, or vomiting blood - call the unit or go to A&E the same day.
Reading your EoE report
Your EoE report in four parts. Read the last one first.
The endoscopy report, the histology report and the treatment plan usually arrive as one bundle. This is what each part means.
A quiet reminder
Histology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report before your review, just ask.
- 01 Header
Indication, EREFS score and biopsy sites
Why the scope was done, the EREFS score (edema, rings, exudates, furrows, strictures), and which oesophageal levels were biopsied.
- 02 Endoscopy
Furrows, rings, exudates and strictures
What was seen: vertical furrows, trachealisation, white plaques, oedema, and any narrowing or crepe-paper mucosa.
- 03 Histology
Peak eosinophil count per high-power field
The key number: ≥15 eos/hpf on the worst biopsy confirms eosinophilic inflammation. Basal cell hyperplasia and eosinophil microabscesses are supporting features.
- 04 Plan
Treatment choice and follow-up scope
Read this first: which of PPI, budesonide, SFED or dupilumab is recommended, and when the re-scope with re-biopsy is booked.
Recognised by major UK insurers
Cover for EoE varies by insurer - gastroscopy with biopsies is routinely funded; budesonide and dupilumab need pre-authorisation. We confirm cover before booking.
Frequently asked
Everything we get asked about EoE.
Quick answers on diet versus medication, re-scopes, insurance, paediatric care, dupilumab access, and long-term maintenance.
-
Diet or medication - which should I try first?
Both are first-line and it is a shared decision. Medication (budesonide orodispersible or a PPI) is simpler day-to-day and works quickly. Six-food elimination diet identifies the actual food trigger, avoids long-term drug use, and gives real control - but it is demanding, needs a dietitian, and requires multiple re-scopes over 6 to 12 months.
-
Why do I need repeat biopsies?
EoE is defined histologically, so remission is confirmed histologically - not by symptoms alone. A re-scope with re-biopsy at 8 to 12 weeks after starting treatment shows whether the eosinophil count has dropped below 15/hpf. During SFED re-introduction, each new food group needs a re-biopsy to identify the trigger.
-
Will private insurance cover EoE care?
Diagnostic gastroscopy with biopsies is usually covered by Bupa, AXA, Vitality, Aviva, WPA, Cigna and Healix when symptoms warrant it. Budesonide orodispersible and dupilumab are often reimbursed on medical necessity - we check cover in writing before booking. Elimination diet dietetics may be self-pay or partly covered.
-
My child has been diagnosed - is the pathway the same?
The principles are the same (biopsy-based diagnosis, PPI/steroid/diet/dupilumab) but paediatric EoE needs paediatric gastroenterology and paediatric dietetics from day one - growth, nutrition and feeding behaviour all matter. Great Ormond Street International Private and the Portland Hospital run dedicated paediatric EoE clinics.
-
How do I access dupilumab privately?
Dupilumab (Dupixent) is NICE approved (TA898, October 2023) for patients aged 12 and over with EoE refractory to two lines of standard therapy. Private access requires a consultant prescription, insurance pre-authorisation or self-pay (£1,200-£1,600 per month), and homecare delivery of weekly injections.
-
Is EoE a lifelong condition?
Yes. EoE is chronic and relapses within months in most patients when treatment is stopped, so a long-term maintenance plan is agreed at diagnosis - usually the lowest effective dose of budesonide, ongoing avoidance of an identified food trigger, or continued dupilumab. Untreated EoE leads to progressive oesophageal remodelling and strictures.
Private EoE clinic · London
Ready to be seen by a specialist EoE consultant?
Send us your symptoms or a prior scope report and we come back within one working day with a named consultant, an indicative price, and insurance guidance - all free of charge.
Related
Related tests, treatments and conditions.
-
Gastroscopy
Diagnostic upper GI endoscopy with biopsies - the foundation of EoE diagnosis.
Learn more -
TIF fundoplication
Transoral incisionless fundoplication for reflux that has not responded to PPI.
Learn more -
POEM for achalasia
Per-oral endoscopic myotomy for achalasia - a different cause of adult dysphagia.
Learn more -
RFA for Barrett’s oesophagus
Radiofrequency ablation for Barrett’s dysplasia - another oesophageal endoscopic therapy.
Learn more -
Component-resolved allergy testing (ISAC / ALEX)
Molecular allergy testing to guide EoE elimination diets in atopic patients.
Learn more -
Acid reflux (GORD)
The condition EoE is most often mistaken for - and often ruled out with a PPI trial.
Learn more