Eosinophilic esophagitis is the leading cause of dysphagia in an outpatient setting.

Background and aim: Dysphagia is an alarming symptom often associated with upper gastrointestinal organic diseases. Its incidence has increased in the last decades, although updated clinical data related to patients presenting with dysphagia are lacking. Thus, in this study, we aimed to provide an update of the main characteristics of patients presenting with dysphagia to an outpatient clinic.

Methods: We retrospectively evaluated consecutive patients first referred to our outpatient clinic (June 2021-December 2022) for dysphagia as the main symptom. All patients underwent upper digestive endoscopy as the first diagnostic examination, with or without biopsies. According to clinician assessment, patients also underwent high-resolution manometry (HRM).

Results: During the study period, a total of 78 patients met the inclusion criteria. Endoscopy showed abnormal features in 25 patients (32.1%), and the most common findings were those associated with eosinophilic esophagitis (n = 8, 10.3%). Biopsies of the esophagus and/or cardia were obtained in 61 patients (78.2%), and 28 patients had abnormal histologic findings. Overall, the most common histological diagnosis was eosinophilic esophagitis, identified in 12 patients (15.3%), with 4/12 (33.3%) without endoscopic alterations suggestive of this diagnosis. HRM was performed in 34/78 patients (43.6%), and in these patients, achalasia was the most common diagnosis (7/34, 20.6%).

Conclusion: Among patients complaining of dysphagia referred to an outpatient gastroenterology clinic, eosinophilic esophagitis is the most common underlying cause of the symptom. Given its high frequency, biopsies should always be performed in patients with dysphagia, regardless of endoscopic findings.