THREE BROTHERS WITH DYSPHAGIA

Abstract

Introduction: The purpose of this report is to describe the presentation of three adult brothers with dysphagia all of whom were ultimately diagnosed with eosinophilic esophagitis. Case 1-Brother number one: A 41-year-old man presented with symptoms of heartburn and intermittent dysphagia. Past medical history was notable for asthma as a child. Physical exam and laboratory data were within normal limits. An upper endoscopy revealed narrowing of the distal esophagus. Biopsies were notable for active esophagitis with marked infiltrate of eosinophils (>20 per high power field). Biopsies of the antrum were normal. He was diagnosed with eosinophilic esophagitis and is now maintained on ingested inhaled fluticasone with adequate relief in his symptoms Case 2-Brother number two: A 34-year-old man is referred to our clinic by his brother for a ten-year history of intermittent dysphagia. He reports dysphagia for solids greater than liquids. He had no other past medical history and physical exam was unremarkable. Labs were notable for a white blood cell count of 6.1 with 11.5% eosinophils. Upper endoscopy revealed linear ulcers in the esophagus. Biopsies of the distal and middle esophagus revealed numerous, degranulating intraepithelial eosinophils. He was diagnosed with eosinophilic esophagitis and treated successfully with ingested inhaled fluticasone. Case 3-Brother number three: A 44-year-old man presented to the emergency department with a food impaction. He had been eating a hot dog when he noted he was unable to swallow the bolus. Family history was notable for two brothers with eosinophilic esophagitis. Physical exam revealed a gentleman in mildly acute discomfort. An urgent upper endoscopy was performed and the foreign body was extracted from the middle third of the esophagus. Biopsies from a repeat endoscopy following resolution of his acute symptoms revealed a predominant infiltrate of eosinophils (>40 per high power field). Treatment for eosinophilic esophagitis was initiated Discussion- Eosinophilic esophagitis is an emerging entity that is likely underdiagnosed in the adult population. Comparisons between the immunopathogenesis of asthma and eosinophilic esophagitis assist in an elucidation of the potential hereditary component of eosinophilic esophagitis. This series of three brothers with eosinophilic esophagitis highlights potential hereditary features of the disease. This association has not been previously reported.