6/2/17 Intern Morning Report – Asthma, Dysphagia, Food Impaction, Eosinophilic Esophagitis

CC: trouble swallowing solids, food impaction

ID:  35-year-old male with asthma and intermittent difficulty in swallowing solids for 2 years presents with food impaction after eating a chicken sandwich.  He had a negative review of systems. Exam showed no evidence of oropharyngeal dysfunction nor cranial nerve deficits.  Patient had an elevated absolute eosinophil count of 1000 cells/uL but otherwise normal labs.  EGD showed normal esophageal mucosa but biopsy results of the distal esophagus demonstrated increased intramucosal eosinophils (>20/HPF) consistent with eosinophilic esophagitis.

If odynophagia occurs with dysphagia, the differential changes:

• Pill esophagitis
• Infectious esophagitis
• Caustic injury
• Crohn’s
• Behcet’s

Pearls from Morning Report:

• Majority of patients with eosinophilic esophagitis (EoE) have allergies, asthma, eczema, or allergic rhinitis
• 50% of EoE patients will have peripheral eosinophilia
• EGD can show rings, edema, longititudinal furrows
• Complications of EoE include stricture, food impaction, perforation
• 30-50% of EoE patients have improvement on PPI