This 28 year old male was having years of swallowing difficulty.
Careful inspection of the oesophagus reveals furrows, cracked lines and exudates – all in keeping with eosinophilic oesophagitis (EOE)
In addition to classical symptoms of oesophageal dysfunction, and findings at endoscopy, oesophageal biopsies are required to confirm the diagnosis.
It is generally recommended that at least 4 biopsies are taken from the distal oesophagus, as well as additional biopsies from either the mid or proximal oesophagus.
Oesophageal biopsies from patients with EOE show an increased number of eosinophils. A threshold of at least 15 eosinophils per high power field (400x), in at least one biopsy specimen, is generally required for the diagnosis.
Initial therapy for this allergic condition of the oesophagus often involves evaluation by an allergist or immunologist, and an exclusion diet where food allergies are detected.
The use of ingested steroid puffers traditionally used for asthma can also be very effective in reducing the oesophageal inflammation.
Proton Pump inhibitors are also often used, for a duration of 8 weeks or more.
Sometimes, swallowing difficulties in this disorder are related to strictures of the oesophagus which may need endoscopic dilation for symptom relief.
