A 17-year-old boy presents to his physician for evaluation of progressive difficulty swallowing solid foods for the past year. His mother reports that he has a history of asthma, allergic rhinitis, and eczema. Over the past year, he has experienced several episodes in which food seemed to become stuck in his chest while eating, and it has recently become more bothersome. He takes albuterol as needed and uses an intranasal corticosteroid. Temperature is 36.8°C (98.2°F), blood pressure is 118/72 mm Hg, pulse is 74/min, and respiratory rate is 14/min. Upper endoscopy demonstrates concentric esophageal rings and linear furrows.
Which of the following is the most likely diagnosis?
The correct answer is:
B) Eosinophilic esophagitis
This patient has progressive solid-food dysphagia, food impaction, atopic disease, and endoscopic findings characteristic of eosinophilic esophagitis. Eosinophilic esophagitis is an immune-mediated condition characterized by eosinophilic infiltration of the esophagus and is strongly associated with allergic disorders.
Answer choice A: Achalasia, is incorrect.
Achalasia typically causes dysphagia to both solids and liquids and is associated with impaired lower esophageal sphincter relaxation.
Answer choice C: Esophageal adenocarcinoma, is incorrect.
Esophageal cancer is uncommon in adolescents and is not associated with this patient’s strong atopic history.
Answer choice D: Gastroesophageal reflux disease, is incorrect.
GERD can cause esophageal symptoms but does not typically produce rings and recurrent food impactions.
Answer choice E: Zenker diverticulum, is incorrect.
Zenker diverticulum usually presents in older adults with regurgitation of undigested food and halitosis.
Key Learning Point
Eosinophilic esophagitis should be suspected in patients with atopy, food impactions, and endoscopic findings of esophageal rings and furrows.
