Eosinophilic Esophagitis: An Uncommon Cause of Dysphagia in India

A 42-year-old gentleman sought evaluation at our department, conveying a history of episodic dysphagia dating back to childhood, currently exacerbated by acute symptoms occurring within the past day subsequent to meal ingestion. Additionally, the patient disclosed a medical background of chronic urticaria, managed with Ayurvedic interventions. His general physical and systemic examination was within normal limits. His routine investigations including complete hemogram and peripheral smear were normal. His esophagogastroduodenoscopic (EGD) examination revealed esophageal rings, longitudinal furrows, along with the presence of impacted food bolus at 28 cm from the incisor ([Fig. 1]). Impacted food bolus was removed with foreign body forceps, and rest of the EGD examination showed normal study for stomach and duodenum. Biopsies obtained from the upper, mid, and lower regions of the esophagus yielded evidence indicative of esophageal eosinophilia, supported by eosinophil counts reaching up to 40 per high-power field, and a reported histology scoring system score of 0.5 ([Fig. 2]). Patient was started on trial of twice daily proton-pump inhibitor (pantoprazole 40 mg twice a day) for 2 months, after which repeat endoscopy and mucosal biopsy were performed. Repeat biopsy revealed persistence of esophageal eosinophils confirming diagnosis of immune-mediated eosinophilic esophagitis (EoE). Patient was started on dietary management and topical steroids.