First AD

Second AD

A 32-year-old man presents with dysphagia to solid foods. His symptoms have increased in frequency during the past 6 months. He has taken to eating much more slowly and needs water to help swallow food. His history is remarkable for seasonal allergies, for which nasal fluticasone is prescribed. He undergoes an upper endoscopy, which demonstrates diffuse rings, longitudinal furrows, and white plaques. Esophageal biopsies reveal dense eosinophilia throughout.

A. Start swallowed topical corticosteroids

B. Refer to allergist for skin prick testing

C. Begin treatment with an acid suppressant

Answer: C. Begin treatment with an acid suppressant

The first step in management of this patient is a 6- to 8-week trial of proton pump inhibitor (PPI) therapy. Approximately one-third of patients will respond histologically, and even more will respond clinically. If response is achieved, then this patient has PPI-responsive esophageal eosinophilia. If, however, symptoms and eosinophilia persist, then either topical corticosteroids or specialized diets should be the next step. Dilation is a very effective treatment option in patients with symptoms secondary to a stricture.

Gastrointestinal Disorders

These endoscopic findings help explain worsening dysphagia in a 32-year-old man. Esophageal biopsies prove positive for eosinophilia. How would you proceed? 

Esophageal Rings, Furrows, and Plaques: What Next?