Eosinophilic Esophagitis

We discussed a case of a young man with history of severe persistent asthma who presents with difficulty swallowing – specifically a sensation of food stuck mid-chest. He has difficulty with solids>liquids. Patient had an EGD showing a “feline” esophagus or ring-like appearance of the esopahgus.

Diagnostic criteria for EOE

  1. Symptoms of EOE
  2. >15 eosinophils on HPF
  3. Exclusion of other causes of EOE including GERD (GERD is thought to increase eosinophils, we often treat GERD and re-test for presence of eosinophils and symptoms before diagnosing EOE however more recently, research shows that EOE and GERD are not mutually exclusive)

Treatment for EOE

  1. Dietary elimination of allergens
  2. PPI
  3. TOPICAL steroids (swallow Fluticasone)
  4. Dilation for symptomatic relief
  5. Recent biologic agents

Patient progressed to have peripheral eosinophilia and worsening persistent asthma. Most patients with EOE have peripheral eosinophilia and high IgE. Due to patient’s persistent asthma, he was placed on a biologic which improved his asthma exacerbations.

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