MEDizzy
MEDizzy
DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKHover 3 years ago
Trachealization” of the Esophagus

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 (Fig. S1 in the Supplementary Appendix). 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. The patient was treated with an 8-week course of omeprazole, but there was no symptom resolution or histologic improvement on repeat endoscopic biopsies, which confirmed the diagnosis of eosinophilic esophagitis. He was started on an 8-week course of both swallowed fluticasone and a six-food elimination diet (elimination of the six most commonly identified types of allergenic food — wheat, milk, soy, nuts, eggs, and seafood). No additional endoscopies were performed after completion of treatment with fluticasone and the elimination diet. At a 1-year follow-up visit, the patient reported no further symptoms of food impaction.

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Top rated comment
over 3 years ago

Nice

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