Esophageal foreign body impaction as a presentation of underlying eosinophilic esophagitis

Introduction. Eosinophilic esophagitis (EoE) is a rare pathology characterized by chronic inflammation with mucosal eosinophilic infiltrate of the esophagus. The clinical symptoms vary according to the age group, from recurrent abdominal and thoracic pain, vomiting, dysphagia, food impaction and gastroesophageal reflux symptoms refractory to treatment with proton pump inhibitors. In the recent years, different studies suggest that EoE is now the leading cause of food impaction in the adult population. Case presentation. A 30-year-old female, without a pathological personal history, was admitted with symptoms of esophageal food impaction. Upper endoscopy revealed esophageal rings and the bolus impacted in the lower esophagus. Biopsy samples were obtained from several different locations, including areas away from the site of food impaction. Histopathologic examination revealed esophageal mucosal eosinophilic infiltrate >15 eosinophils per high-power field. Proton pump inhibitor (PPI) therapy, twice-daily dosing for 8 weeks was administered, as the first line treatment. Conclusions. Consensus guidelines for the diagnosis of EoE require symptoms of esophageal dysfunction, 15 or more eosinophils per high-power field on microscopic examination of esophageal biopsy after 8 weeks on a high-dose proton pump inhibitor (PPI), and the absence of alternative causes of eosinophilia.