6/2/17 Intern Morning Report – Asthma, Dysphagia, Food Impaction, Eosinophilic Esophagitis

CC: trouble swallowing solids, food impaction

ID:  35-year-old male with asthma and intermittent difficulty in swallowing solids for 2 years presents with food impaction after eating a chicken sandwich.  He had a negative review of systems. Exam showed no evidence of oropharyngeal dysfunction nor cranial nerve deficits.  Patient had an elevated absolute eosinophil count of 1000 cells/uL but otherwise normal labs.  EGD showed normal esophageal mucosa but biopsy results of the distal esophagus demonstrated increased intramucosal eosinophils (>20/HPF) consistent with eosinophilic esophagitis.

 

If odynophagia occurs with dysphagia, the differential changes:

  • Pill esophagitis
  • Infectious esophagitis
  • Caustic injury
  • Crohn’s
  • Behcet’s

Pearls from Morning Report:

  • Majority of patients with eosinophilic esophagitis (EoE) have allergies, asthma, eczema, or allergic rhinitis
  • 50% of EoE patients will have peripheral eosinophilia
  • EGD can show rings, edema, longititudinal furrows
  • Complications of EoE include stricture, food impaction, perforation
  • 30-50% of EoE patients have improvement on PPI
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