Gastro Case Challenge: A 33-Year-Old Man Who Can’t Swallow His Own Saliva

Juan Carlos Munoz, MD; Carmela Monteiro, MD; Ivan E. Rascon-Aguilar, MD


September 06, 2022


Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It was first reported in 1978,[1] and its incidence appears to be increasing. It is a condition that mainly affects children; the adult form has only recently gained recognition as a distinct entity. It is characterized clinically by dysphagia. Often, the patient's history of dysphagia dates to childhood or adolescence.

In a study by Desai and colleagues,[2] the authors reported that eosinophilic esophagitis may have an identical appearance to a Schatzki ring, as seen in this case. In some patients, eosinophilic esophagitis may occur in association with eosinophilic gastroenteritis.[2]

The cause of eosinophilic esophagitis is poorly understood. Most studies have mentioned a high prevalence of allergies in family members. It is not clear whether eosinophilic esophagitis has a purely genetic base or whether this condition occurs in genetically predisposed individuals with an environmental trigger. In many cases, the disease manifestations are intermittent in nature.

Most adult patients with eosinophilic esophagitis are men (the male-to-female ratio is 3:1). Most commonly, patients present in the third or fourth decade of life. The presenting symptoms include dysphagia (93%), food impaction (62%), and heartburn (24%). More unusual manifestations of eosinophilic esophagitis include odynophagia, atypical chest pain, and vomiting.

Most adult patients with eosinophilic esophagitis do not respond to antisecretory therapy and may have objective evidence of reflux on a 24-hour pH study. About 50% of patients give a history of allergies (food, atopic dermatitis, allergic rhinitis) and 31% have peripheral blood eosinophilia. Serum immunoglobulin E (IgE) levels are increased in about 55% of patients.


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