Case 8: Summary

Diagnosis:  Esophageal food impaction with underlying eosinophilic esophagitis

Case Summary:

Screen Shot 2021-05-19 at 10.26.29 AM

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


  1. Abdel Jalil AA, Katzka DA, Castell DO. Approach to the patient with dysphagia. Am J Med. 2015 Oct;128(10):1138.e17-23. doi: 10.1016/j.amjmed.2015.04.026. Epub 2015 May 23. PMID: 26007674.
  2. Libânio D, Garrido M, Jácome F, Dinis-Ribeiro M, Pedroto I, Marcos-Pinto R. Foreign body ingestion and food impaction in adults: better to scope than to wait. United European Gastroenterol J. 2018 Aug;6(7):974-980. doi: 10.1177/2050640618765804. Epub 2018 Mar 14. PMID: 30228884; PMCID: PMC6137585.
  3. Hirano I, Chan ES, Rank MA, Sharaf RN, Stollman NH, Stukus DR, Wang K, Greenhawt M, Falck-Ytter YT; AGA Institute Clinical Guidelines Committee; Joint Task Force on Allergy-Immunology Practice Parameters. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Gastroenterology. 2020 May;158(6):1776-1786. doi: 10.1053/j.gastro.2020.02.038. PMID: 32359562.
  4. Gómez-Aldana A, Jaramillo-Santos M, Delgado A, Jaramillo C, Lúquez-Mindiola A. Eosinophilic esophagitis: Current concepts in diagnosis and treatment. World J Gastroenterol. 2019 Aug 28;25(32):4598-4613. doi: 10.3748/wjg.v25.i32.4598. PMID: 31528089; PMCID: PMC6718043.

If you enjoyed this case, please click here to take a moment to complete our survey. Or Click here to return to the home screen and select a new case!

Case 8 Index:
Physical Exam
Differential Diagnosis
Diagnostic Testing

GiSIM Home