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Eosinophilic Esophagitis-Related Dysphagia in a Young Woman

Eosinophilic Esophagitis-Related Dysphagia in a Young Woman

A 25-year-old woman presented to the GI clinic complaining of intermittent solid food dysphagia. She is a nonsmoker with a remote history of seasonal allergies. She has no history of asthma or allergies to medications or food. She had been treated 5 years earlier for the same symptoms with an 8-week course of lansoprazole, 30 mg twice daily, which was not effective. An esophagogastroduodenoscopy (EGD) performed at that time showed linear furrowing with trachealization (Figures 1 and 2).


Figure 1


Figure 2

Tissue biopsy specimens from the mid- and distal esophagus confirmed a diagnosis of eosinophilic esophagitis (EoE). Treatment was started with a 6-month course of fluticasone, 220 µg, 2 puffs swallowed twice a day, and lansoprazole, 30 mg twice daily. There was no improvement in symptoms despite the patient’s adherence to therapy.

Over the following 3 years, the patient experienced 4 food impactions and underwent multiple esophageal dilations for symptomatic relief. She did not respond to multiple trials of fluticasone, esomeprazole, and lansoprazole. She also followed dietary modifications, including lactose- and gluten-free regimens, but there was no improvement in symptoms. The patient discontinued all pharmacologic therapy 6 months before her present visit and followed only dietary modifications, including eating small meals with increased liquid intake. Her symptoms remained stable without recurrence of impactions for approximately 4 months.

The patient was stabilized after the current impaction, and treatment was initiated with viscous budesonide, 2 mg twice daily; symptoms improved remarkably within 2 weeks of beginning treatment (Figure 3). Therapy with budesonide was continued for 3 months. There was no recurrence of symptoms. The patient remained completely symptom-free at the 6-month follow-up and has not required further medical management.

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