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