Management of Esophageal Stricture and Perforation Complicated by Undiagnosed Eosinophilic Esophagitis and Pill Impaction.

Abstract

Eosinophilic esophagitis (EoE) is a chronic-immune-mediated disease, characterized by esophageal dysfunction secondary to eosin-ophilic infiltration. EoE is now the leading cause of dysphagia and food impaction in both children and young adults (1). The incidence and prevalence is rising, with an estimated pediatric incidence of 0.7 to 10 cases per 100 000 person-years (2). Genetic predisposition, gene-environment interactions, and comorbidities increases one’s risk of developing disease (3). EoE affects all ages, with clinical presentation varying with age (1). Infants may present with failure to thrive and food refusal, whereas adolescents typically present with dysphagia and impaction (1). Diagnosis can be challenging due to symptoms that can mimic or occur concomitantly with symptoms of other diagnoses or be unintentionally masked by adaptive techniques (1–3). Schoepfer et al report that younger patients have longer diagnostic delay, with a gradual decrease in delay with increased age. Under-recognition of disease can lead to a median delay of up to 6 years and increase one’s risk of complications, including fibrostenosis and stricture development (4).This case describes a perforation in an esophageal stricture secondary to undiagnosed EoE and subsequent successful management. We highlight the need for increased disease recognition, and the complications associated with delayed diagnosis.