Recurrent Dysphagia: Think about Eosinophilic Esophagitis

Introduction: Eosinophilic esophagitis is a chronic inflammatory pathology, poorly understood, characterized by isolated dense infiltration of the esophageal mucosa by eosinophils, associated with upper digestive symptoms, caused by allergens that can be food or aeroallergens. Case observation: This is a 35-year-old patient with a history of recurrent episodes of allergic rhinitis who had repeated and paroxysmal episodes of high dysphagia for two years, occurring after food intake and predominating on solids. The clinical examination was normal, the standard biological assessment revealed Hb: 14.1 g/dl GB: 12,000 ele/mm3 with hypereosinophilia at PNE: 540 ele/mm3 and PLQ: 250,000 ele/mm3 renal function as well that the blood ionogram were without abnormalities. Esophageal endoscopy found a foreign food body upstream of a narrowed aspect of the esophageal lumen of the middle third of the esophagus with erythematous and congestive esophageal mucosa. An extraction of food residues was carried out with additional balance sheet. A cervico-thoracic scan showed a ringed and isolated arrangement of the middle esophagus. Esophageal manometry did not identify motor disorders. Staged biopsies of the esophagus showed eosinophilic polymorphonuclear exocytosis at a rate of 30 intraepithelial eosinophilic polymorphonuclear cells per field at high magnification. The blood dosage of Total IgE returned slightly increased to 250 kU/L. the diagnosis of eosinophilic esophagitis was retained. Discussion: Eosinophilic esophagitis considered a rare disease, the symptoms vary with age, mainly dysphagia to solids (70%) and symptoms suggestive of gastroesophageal reflux (40%), it may be associated with manifestations atopic. The first examination requested must be a gastroscopy with biopsies, it is therefore essential and must be accompanied, in all cases, by biopsies of the esophagus. There are characteristic, but not pathognomonic, images of eosinophilic esophagitis, namely strictures, ....