[Impaction of a "sausage bread" in the esophagus--first manifestation of an eosinophilic esophagitis in a 17-year-old patient].
A 17-year-old patient was transferred to the emergency room with an impacted food bolus by colleagues from the Department of Otorhinolaryngology. The examination of ear, nose and throat revealed significant amounts of saliva in both recessus piriformis, a radiologic examination of the esophagus showed a foreign body with a diameter of 1.6 cm in the region of the transitional zone of esophagus and stomach with a support level of the contrast medium. Clinical examination and laboratory tests showed no abnormalities. An emergency gastroscopy was performed. The foreign body, already evident in the barium swallow, was found in the distal esophagus. The foreign body was identified as a food bolus and gently advanced into the stomach with the aid of the gastroscope. In the stomach further food residues were detected and the examination was aborted because of increased risk of aspiration. On the next day, an elective gastroscopy was performed. Several biopsies were obtained from the esophagus because eosinophilic esophagitis (EE) was suspected due to clinical symptoms. Histological work-up showed a significant amount of eosinophilic granulocytes (> 15 eosinophils/HPF, 400 x) and reactive changes in the distal esophagus. Therefore, EE was diagnosed. Fluticasone therapy led to amelioration of symptoms and there was no evidence of recurring bolus impaction during follow-up.
Gäbele
Erwin
E
Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, Regensburg, Germany. erwin.gaebele@klinik.uni-regensburg.de
Endlicher
Esther
E
Zuber-Jerger
Ina
I
Uller
Wibke
W
Eder
Fabian
F
Schölmerich
Jürgen
J
D000280:Administration, Inhalation; D000293:Adolescent; D000730:Androstadienes / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001706:Biopsy; D001939:Bread; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000175:diagnosis* / Q000473:pathology; D004941:Esophagitis / Q000175:diagnosis* / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology; D000068298:Fluticasone; D005547:Foreign Bodies / Q000175:diagnosis*; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D012008:Recurrence; D012130:Respiratory Hypersensitivity / Q000150:complications / Q000188:drug therapy
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone