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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 5  |  Issue : 1  |  Page : 80-81

Eosinophilic esophagitis: Food impaction as a diagnostic prompt


Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA

Date of Web Publication23-Apr-2019

Correspondence Address:
Dr. Thomas J Papadimos
Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, Ohio 43560
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_15_18

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How to cite this article:
Stark CE, Merchant S, Papadimos TJ. Eosinophilic esophagitis: Food impaction as a diagnostic prompt. Int J Acad Med 2019;5:80-1

How to cite this URL:
Stark CE, Merchant S, Papadimos TJ. Eosinophilic esophagitis: Food impaction as a diagnostic prompt. Int J Acad Med [serial online] 2019 [cited 2019 May 21];5:80-1. Available from: http://www.ijam-web.org/text.asp?2019/5/1/80/256794



Editor: Although the most common factors related to food impaction are gastroesophageal reflux, esophageal stricture, and Schatzki's ring, we would briefly like to remind our colleagues that such an event, although not unusual, may represent as the initial manifestation of eosinophilic esophagitis (EE).[1] We bring this to your attention because interns and junior residents rotating through the emergency department (ED) and intensive care have little experience with food impactions and the accompanying differential diagnoses, and their inexperience may lead to a delay in diagnosis and/or treatment.

We cared for a 38-year-old Caucasian male who presented to the ED with a complaint of the upper abdominal fullness and pressure after consuming two hot dogs. He also complained of an inability to “swallow his food” and take a deep breath. Before coming to the ED, he experienced emesis of frank blood. Previous to this episode, he had experienced 2 weeks of mild-to-moderate difficulty swallowing liquids and foods. In the ED, he received glucagon and famotidine and was then admitted to the Intensive Care Unit. The gastrointestinal service was consulted late the next day, and an endoscopy was performed that revealed a bleeding mucosal tear and stricture at the mid-esophagus, with multiple pieces of meat lodged at the narrowing [Figure 1]. The bleeding was stopped with several epinephrine injections. An esophageal ring was confirmed with a double contrast esophogram. Biopsies demonstrated eosinophilic esophagitis (EoE). The patient was discharged home 48 h later.
Figure 1: Esophageal food impaction caused by hot dogs

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Such an impaction occurs in over 50% of the adults with EE.[1] In the United States, 13/100,000 have a food impaction, therefore, a significant amount may have EE.[1] Reporting of EE is recent (1995).[2],[3] EE is a “chronic immune/antigen-mediated esophageal disease characterized clinically and by evidence of histologic eosinophil-predominant inflammation.”[4] There are no translational methods for diagnosis, yet endoscopy with biopsies is the only reliable method. Clinically, the typical patient is male, usually non-Hispanic White, and the presentation occurs in childhood or during the third or fourth decades of life.[4] Children present with feeding difficulties, vomiting, or pain.[5] Other symptoms include the upper abdominal pain, chest pain, and heartburn.[5] While treatment may include steroids, esophageal dilations, elimination diets, and mast cell stabilizers or leukotriene inhibitors, our goal here is to ensure teachers and mentors in critical care medicine, anesthesiology, and surgery do not overlook the diagnosis. In this case, the diagnosis was not entertained until the next day.

We encourage our colleagues and their trainees to entertain the diagnosis of EoE when caring for the adult male patients in their third or fourth decade of life who present with food impaction and stricture and to always ensure biopsies are obtained during endoscopy, along with a good history and physical examination to ensure a proper diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT, et al. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc 2005;61:795-801.  Back to cited text no. 1
    
2.
Walsh SV, Antonioli DA, Goldman H, Fox VL, Bousvaros A, Leichtner AM, et al. Allergic esophagitis in children: A clinicopathological entity. Am J Surg Pathol 1999;23:390-6.  Back to cited text no. 2
    
3.
Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA, et al. Eosinophilic esophagitis attributed to gastroesophageal reflux: Improvement with an amino acid-based formula. Gastroenterology 1995;109:1503-12.  Back to cited text no. 3
    
4.
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20.  Back to cited text no. 4
    
5.
Mukkada VA, Haas A, Maune NC, Capocelli KE, Henry M, Gilman N, et al. Feeding dysfunction in children with eosinophilic gastrointestinal diseases. Pediatrics 2010;126:e672-7.  Back to cited text no. 5
    


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