A 17-year-old girl presents to the clinic with a complaint of difficulty swallowing for the past two weeks. She describes occasional episodes where “food seems to stick in my throat.” This mostly occurs with solid foods, and it is sometimes associated with vomiting and abdominal pain. She does not experience urticaria or dyspnea during these episodes. She denies heartburn, hematemesis, and weight loss, and she has no history of psychiatric illness. Her past medical history includes a history of asthma and allergies to tree nuts and shellfish. She does not use alcohol or other drugs. Her medications include albuterol, an oral contraceptive and an epinephrine auto-injector. Physical examination is unremarkable. She is referred to a gastroenterologist who recommends an upper endoscopy.
D) Linear furrow
Linear furrows alone with esophageal rings are classic findings in eosinophilic esophagitis, which presents with dysphagia and food impaction, typically in patients with a history of atopy.
This patient has eosinophilic esophagitis (EoE), a disorder of eosinophilic infiltration of the esophageal mucosa. It is most commonly found in patients with a history of atopy and can present with a wide variety of gastrointestinal symptoms, though it most commonly presents with dysphagia and food impaction. On endoscopy, esophageal rings and linear furrows will be found.
Answer choice A: Esophageal varices, is incorrect. Without a history of alcohol abuse or cirrhosis, there is no reason to suspect esophageal varices. Additionally, varices are often asymptomatic unless they rupture, causing painless hematemesis.
Answer choice B: Esophageal webs, is incorrect. Esophageal webs often present as dysphagia for poorly chewed food and may be associated with iron deficiency anemia in Plummer-Vinson syndrome. Her history and lack of findings suggestive of anemia make this answer less likely.
Answer choice C: Intestinal metaplasia, is incorrect. It would be extremely unlikely for a 17-year-old patient to have intestinal metaplasia, which is indicative of Barrett esophagus. Additionally, she denies heartburn.
Answer choice E: Punched-out ulcers, is incorrect. Punched-out ulcers may be found in HSV-1 esophagitis. Nothing in this patient's history is suggestive of HSV-1 infection.
Key Learning Point
Linear furrows alone with esophageal rings are classic findings in eosinophilic esophagitis, which presents with dysphagia and food impaction, typically in patients with a history of atopy.
