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

Disclosures

September 06, 2022

After specific food allergies are identified, pediatric or adolescent patients can be started on a targeted elimination diet, an elemental diet, or a six-food elimination diet for 6 weeks. Data in adults also suggest that a six-food elimination diet can improve symptoms, improve esophageal eosinophilia, and help to identify causative foods.

Steroids and PPIs are considered to be first-line treatment for eosinophilic esophagitis, alongside diet therapy and esophageal dilation.[3]

In this patient, a large piece of pork was seen in the lower esophagus on endoscopy (Figure 1), which was removed during endoscopy with a commercially available retrieval net device. A lesion with the appearance of a Schatzki ring was identified during the endoscopic evaluation (Figure 2).

Figure 1.

Figure 2.

In addition to a mucosal tear, subtle concentric esophageal rings were seen. Biopsies were taken from the lower and upper esophagus. The biopsy of the lower esophagus revealed a squamous mucosa with reactive changes and marked eosinophilia (> 20 per HPF). A biopsy of the upper esophagus also revealed a squamous mucosa with reactive changes and marked eosinophilia. The prominent eosinophilic infiltrate seen in both biopsies is highly suggestive of eosinophilic esophagitis. The patient was subsequently referred to an allergist for skin prick and/or patch testing for food and other environmental allergens. He was then started on a course of oral fluticasone (as described above). The patient was doing well 6 weeks after the diagnosis, with minimal dysphagia.

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