Acute food impaction in an adult with previously undiagnosed eosinophilic esophagitis

A 31-year-old man with a history of allergic rhinitis, asthma and eczema presented to the emergency department with sudden dysphagia and food impaction while eating steak. He reported intermittent dysphagia and gastroesophageal reflux over several months despite proton pump inhibitor therapy. We dia...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2023-02, Vol.195 (6), p.E234-E235
Main Authors: Patel, Hiral S, Reji, Merin, Krishnaswamy, Guha
Format: Article
Language:English
Subjects:
Adult
Autoimmune diseases
Case studies
Deglutition disorders
Deglutition Disorders - etiology
Diagnosis
Dysphagia
Emergency medical care
Eosinophilic Esophagitis - complications
Eosinophilic Esophagitis - diagnosis
Esophageal diseases
Esophagitis
Esophagus
Food
Foreign bodies (Medical care)
Gastritis
Gastroenterology
Gastroesophageal reflux
Gastrointestinal diseases
Humans
Immunology
Medicine
Pantoprazole
Practice
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Summary:A 31-year-old man with a history of allergic rhinitis, asthma and eczema presented to the emergency department with sudden dysphagia and food impaction while eating steak. He reported intermittent dysphagia and gastroesophageal reflux over several months despite proton pump inhibitor therapy. We diagnosed "steakhouse syndrome," or esophageal food impaction. The gastroenterology team performed urgent esophagogastroduodenoscopy, which showed furrowing and concentric rings, consistent with eosinophilic esophagitis. They extracted the impacted food endoscopically (Figure 1B). Esophageal biopsy showed eosinophilic esophagitis. We prescribed pantoprazole 40mg twice daily and fluticasone propionate 440g twice daily (swallowed, not inhaled). He has since required periodic dilatation of strictures. Esophageal eosinophilia (= 15 eosinophils per high power field) and exclusion of other potential causes of tissue eosinophilia (proton pump inhibitor therapy, Crohn disease, malignant disease, autoimmunity, drug hypersensitivity and parasitic disease) and endoscopy help confirm eosinophilic esophagitis.
ISSN:0820-3946
1488-2329
DOI:10.1503/cmaj.221054