3112 Eosinophilic Esophagitis (EE) Presenting With Severe Dysphagia Showing Dramatic Response to Oral Steroid Therapy

Abstract

INTRODUCTION: During the last decade of clinical practice, a rapid increase of a “new” disease termed as “eosinophilic esophagitis (EE)” have been identified among patients who were thought to have gastroesophageal reflux disease (GERD) but did not respond to medical and/or surgical GERD treatment. Over the last decade eosinophilic esophagitis is increasingly being recognized in adults and children throughout the world. Population-based studies suggest the prevalence to be in excess of 1:1000 with a predilection for white males. The disease is very rare in Bangladesh. CASE DESCRIPTION/METHODS: A 40 years old house wife presented with one-year long history of severe dysphagia with significant weight loss; endoscopic evidence of a long linear ulcer with stricture involving almost the whole length of the esophagus; histopathologic evidences of eosinophilic esophagitis and a dramatic response to systemic steroid therapy. DISCUSSION: Diagnosis of Eosinophilic Esophagitis is based on (i) symptoms including but not limited to food impaction and dysphagia in adults and feeding intolerance and gastro-esophageal reflux symptoms in children; (ii) histological evidence of ≥15 eosinophils /HPF; (iii) exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially gastro-esophageal reflux disease. The overlapping symptoms of EE and GERD sometimes may delay or confuse the diagnosis of the disease in many cases. Most patients present with dysphagia and food impactions, atypical chest pain and heartburn that is refractory to PPI therapy. Fibrosis, narrowing of the lumen and stricture esophagus can occur with EE. Appropriate treatments include dietary approaches based upon eliminating exposure to food allergens, and topical/systemic corticosteroids. This patient presented with severe dysphagia with significant weight loss; endoscopic evidence of a long linear ulcer with stricture involving almost the whole length of the esophagus; histopathologic evidences of eosinophilic esophagitis and a dramatic response to systemic steroid therapy. In conclusion, although EE is a very uncommon disease in Bangladesh, the intent of this report is to grow awareness of the clinicians about this disorder to make early diagnosis and treatment of the disease with systemic steroid to prevent the development of complications like esophageal stricture or perforation.