|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 80-81
Eosinophilic esophagitis: Food impaction as a diagnostic prompt
Carilyn E Stark, Soroush Merchant, Thomas J Papadimos
Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
|Date of Web Publication||23-Apr-2019|
Dr. Thomas J Papadimos
Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, Ohio 43560
Source of Support: None, Conflict of Interest: None
|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
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). 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.
Such an impaction occurs in over 50% of the adults with EE. In the United States, 13/100,000 have a food impaction, therefore, a significant amount may have EE. Reporting of EE is recent (1995)., EE is a “chronic immune/antigen-mediated esophageal disease characterized clinically and by evidence of histologic eosinophil-predominant inflammation.” 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. Children present with feeding difficulties, vomiting, or pain. Other symptoms include the upper abdominal pain, chest pain, and heartburn. 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
Conflicts of interest
There are no conflicts of interest.
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