Introduction Eosinophilic oesophagitis (EO) is an emerging disease and requires a high index of suspicion for diagnosis.
Case report A twelve year old boy presented to the ENT surgeons with painless dysphagia with solids for 6 months. His mother reported him to be a very slow eater since infancy. He had no problems with fluids, and was otherwise a healthy boy.
A barium contrast swallow revealed a shelf-like thin lucent band arising from anterior wall of the oesophagus at fifth cervical level. Rigid endoscopy with dilatation undertaken by ENT surgeons provided only transient symptomatic relief. We did a flexible oesophagoscopy revealing a very abnormal appearance of the oesophageal mucosa with several concentric rings. Mucosal histology (see figure) revealed that there were over 50 eosinophils/high-power field in the mucosa, establishing a diagnosis of EO. The patient was commenced on Fluticasone inhaler given by intended poor technique so that steroid is deposited within the oesophagus. The dysphagia has markedly improved.
Conclusions EO appears to be a rare but increasingly recognised condition world wide. Children with persistent symptoms of dysphagia should be referred to a paediatric gastroenterologist to consider endoscopy and biopsies are taken to exclude this unusual but treatable condition.