A 23-year-old man with asthma and seasonal allergies presents to the emergency department with an acute food bolus impaction. He has had solid food dysphagia since elementary school, but had always been told to chew more carefully. He has not had any prior evaluation, and has never been to the emergency department before, but does have a sensation of food sticking with almost every meal. He minimizes symptoms by eating slowly, chewing thoroughly, and drinking a lot of water with each bite of food. He tends to avoid dry breads and steak, as these always stick. Most of the time when foods stick, if he relaxes himself they will eventually go down. However, sometimes he has to clear the foods with regurgitation. The endoscopic exam shows a food bolus impacted in the proximal esophagus, which is cleared. The esophagus is diffusely narrowed, with edema, rings, and furrows. Biopsies show 85 eosinophils per high-power microscopy field (eos/hpf) from the distal esophagus and 70 eos/hpf from the proximal esophagus. He is started on the proton-pump inhibitor (PPI) omeprazole (20 mg orally twice daily) and has a follow-up endoscopy scheduled in 8 weeks' time. He continues to have frequent dysphagia. The endoscopic findings and biopsy results are unchanged and he is diagnosed with eosinophilic esophagitis (EoE).

asthma | seasonal allergies | acute food bolus impaction | solid food dysphagia | chew more carefully | sensation of food sticking | alleviating by eating slowly | alleviating by chewing thoroughly | regurgitation | food bolus impacted in the proximal esophagus | frequent dysphagia

esophagitis Eosinophilic esophagitis

https://online.epocrates.com/diseases/130422/Eosinophilic-esophagitis/Common-Vignette