Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 1)

An enigma of eosinophilic esophagitis

Authors:
Vladimir Vračarić, Željka Savić, Mirjana Živojinov, Dragomir Damjanov, Žarko Krnetić, Tatiana Jocić

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Introduction. Eosinophilic esophagitis is a chronic immuno-genic-antigen mediated disease of the esophagus, characterized by symptoms related to esophagus dysfunction, histologically defined by over 15 eosinophil counts seen in high-power mi-croscopic field, without gastroesophageal reflux disease. In adults, the most common clinical manifestations are dysphagia, reflux, chest pain, regurgitation and bolus impaction. Case re-port. We presented the case of a female patient, hospitalized for a serious form of pancreatitis with complications, which re-quired artificial ventilation and enteral feeding, after the initial esophagoscopy verified reflux esophagitis. Further treatment cured the primary illness, and peroral feeding was reintroduced. However, dysphagia with regurgitation occurred, and endo-scopic and radiological tests verified esophagus stenosis, which histopathologically corresponded to erosive esophagitis. Two months of treatment by a double dosage of proton pump in-hibitors led to no regression of disorders, and the repeated bi-opsies from the stenotic segments resulted in over 30 eosino-phil counts in the high-power microscopic field, which his-tologically corresponds to eosinophilic esophagitis. Subsequent therapy included fluticasone 880 μg/day orally for a period of eight weeks, which led to complete regression of disorders, and endoscopic and histopathologic remission. Conclusion. In case of irresponsiveness to the conventional therapy by proton pump inhibitors, repeated esophagoscopy and histopathologi-cal analyses of esophagus mucosa biopsy can point to the diag-nosis of eosinophilic esophagitis, and a good therapeutic re-sponse to topical corticosteroids can be regarded as the clinical confirmation of the diagnosis.