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.

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Figure 1

Jauhari et al

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.