Esophageal Polyps: A Rare Presentation of Eosinophilic Esophagitis

Abstract

Purpose: Initial presentation: A 61 year old female, without any significant past medical history, presented to the clinic with 3 months of heartburn, dysphagia, and recent regurgitation of food. Her physical exam, and laboratory data were all unremarkable. An upper endoscopy was done which demonstrated multiple sessile polyps <5 mm in diameter in the upper two thirds of the esophagus, all of which were removed with cold forceps. (Figure A) There were also linear furrows noted throughout the esophagus. Pathology: The histology of the esophageal polyps revealed polypoid squamous mucosa with increased intraepithelial lymphocytes and >70 eosinophils per high power field consistent with eosinophilic esophagitis. (Figure B) Clinical course: Subsequent to her endoscopy, she admitted to significant intake of nuts in her diet. She was placed on fluticasone to be swallowed nightly, as well as a diet free of nuts. Upon her six week follow up, she reported resolution of her symptoms. Discussion: Eosinophilic esophagitis (EE), first described in the 1970s, is characterized by >15 eosinophils per high power field in concordance with symptoms of heartburn, regurgitation, dysphagia, or food bolus impactions. Typical endoscopic features that have been described have included horizontal rings, linear furrows, whitish exudates, granularity and ulceration. This case involved a unique endoscopic finding of esophageal polyps in the context of eosinophilic esophagitis. This is a rare finding which has mostly been described in the pediatric literature. There is no evidence to suggest that these polyps are premalignant; however, this case should heighten awareness of the association of EE with polyps of the esophagus.Figure: Polyps and furrows.Figure: Eosinophils.