I would like to thank you for the recent clinical intelligence article on eosinophilic oesophagitis.1 As a current GPVTS working in ENT I found this clinical update very informative and relevant to my work. Interestingly only a few days after reading this article we admitted a 17-year-old young man complaining of a food bolus sensation following eating chicken earlier in the day. He was normally fit and well, and of note did not suffer with any atopic conditions. He was managed initially with medical therapy, however, after some initial improvement his symptoms deteriorated and the time between consumption and regurgitation of water progressively shortened.
A gastrograffin swallow was arranged, by which stage the patient was struggling to swallow his saliva. Gastromiro was used and the procedure identified almost complete obstruction at approximately the distal one-third of the oesophagus. Gastromiro is a water-soluble contrast agent and was chosen because it is easier to swallow than barium, and is non-toxic. An urgent OGD identified retained food and fluid in the oesophagus. Linear furrows and concentric ring constrictions were noted in the oesophagus at OGD. Multiple random biopsies were taken and had been found to be diffusely infiltrated with eosinophils, consistent with a diagnosis of eosinophilic oesophagitis.
This article and subsequent case have significantly increased my awareness of this condition and brought it to the forefront of my mind when considering differential diagnoses of food boluses.
- © British Journal of General Practice 2012