Abstract :

Background: Eosinophilic esophagitis (EoE) is an uncommonly diagnosed esophageal disease characterized by dysphagia and food impaction. Differentiation between the other causes of these symptoms, particularly gastroesophageal reflux disease (GERD), could be challenging, as not only can EoE and GERD overlap, but they can also impact each other. Guidelines for best practices have only recently been developed. It affects 1 in 1000 people, mostly young men. Case Report: A 27-year-old male was referred to our institution in March 2022 with a 3-year history of persistent dysphagia for solid foods with recurrent episodes of a sensation of food impaction, requiring fluid for resolution. Upper endoscopy revealed an abnormal esophagus with macroscopic features of EoE, and histologic examination showed infiltration of more than 35 eosinophils/high-power field, which confirmed the diagnosis of EoE. Treatment was initially begun with budesonide along with Esomeprazole, which was started months before endoscopy. Symptoms improved gradually during the following 3 months, and a repeat endoscopy revealed significant improvement of the endoscopic and histologic features. The patient remained in remission on follow-up at 9 and 24 months. Conclusion: This case discusses how to evaluate food impaction as well as the diagnostic criteria for EoE. Since the diagnostic and treatment guidelines for EoE are relatively new, it is easy for the primary care physician to overlook it, causing a delay in specialist consultation and thus delaying treatment.