Diagnosis: Esophageal food impaction with underlying eosinophilic esophagitis
This patient presented with concern for esophageal food impaction in the setting of long standing non progressive dysphagia to solids. Details from history and physical can help generate an appropriate differential for dysphagia and order appropriate diagnostic tests (as shown in the figure). Urgent endoscopy is warranted when esophageal food impaction is suspected.
Eosinophilic esophagitis is a chronic immune-mediated esophageal disease characterized by dysphagia, food impactions, and esophageal eosinophilia. The diagnosis is made by symptoms, characteristic findings on upper endoscopy, and greater than or equal to 15 eosinophils per high powered field on biopsies taken from the proximal and distal esophagus. Management options include proton pump inhibitors, 6 food dietary elimination and corticosteroids.
Case authored by: Lauren Donnangelo MD and Bhavana Bhagya Rao MD
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