Oesophageal appearances of eosinophilic oesophagitis

A 33-year-old man presented with recent-onset (1 month) sticking of food in the retrosternal area. The symptoms occurred with the consumption of specific food items like pulses only. He did not have odynophagia, skin rash, asthma or urticaria. Physical examination was unremarkable. Laboratory data showed a normal total white blood count and a slightly elevated absolute eosinophil count of 580/ μl. Endoscopy revealed multiple fixed rings in the esophagus (Figure  1A) starting from 26  cm from incisors and extending up to the gastroesophageal junction, suggestive of eosinophilic esophagitis (EoE). Endoscopic esophageal biopsy showed numerous eosinophils (>30/hpf) in the mucosa (Figure  1B, arrow). The patient was managed with oral pantoprazole, dietary modifications to avoid pulses and to swallow inhalational fluticasone propionate (through a metered-dose inhaler), and had symptomatic improvement with the therapy.
Source: QJM - Category: Internal Medicine Source Type: research