Trachealization of the esophagus
Images in Clinical Medicine: “Trachealization” of the Esophagus. ⠀ ⠀ A 32-year-old man presented to the emergency department with difficulty swallowing oral secretions and the feeling that food was stuck in his throat after he ate a pizza roll. The patient reported that similar episodes had occurred previously, but in each instance the feeling resolved spontaneously, and he did not seek medical care. At the time of presentation, the patient was drooling. Upper endoscopy revealed impacted food material (Panel A) and prominent mucosal rings extending 20 cm from the incisors to the level of the gastroesophageal junction, with two discrete areas of narrowing and associated linear furrows (Panel B). Biopsy specimens were obtained, and esophagitis was observed, with more than 40 eosinophils per high-power field. An endoscopic finding of fixed esophageal rings, or “trachealization,” is suggestive of eosinophilic esophagitis, although a definitive diagnosis is made on the basis of clinical presentation, histologic findings, and the exclusion of other causes of esophageal eosinophilia, such as proton-pump inhibitor–responsive esophageal eosinophilia.
