Eosinophilic Esophagitis After Radiofrequency Ablation of Barrett's Esophagus in a 41-Year-Old Man.

BACKGROUND Gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) can contribute to the development of esophageal eosinophilia, specifically after radiofrequency ablation (RFA). Eosinophilic esophagitis (EoE) after treatment for BE is much rarer. EoE is a chronic, immune-mediated disease of the esophagus, commonly presenting with symptoms such as dysphagia and heartburn. Diagnosis is established based on histological evaluation of esophageal biopsies. This report describes a 41-year-old man with chronic GERD and BE with symptomatic EoE, following RFA. CASE REPORT A 41-year-old male patient with a history of GERD spanning over a decade and BE treated with RFA in 2013 was admitted to the Department of Gastroenterology in April 2024 for routine upper endoscopy with biopsy sampling. Esophagogastroduodenoscopy (EGD) revealed significant abnormalities throughout the esophagus, including pronounced trachealization, longitudinal furrows, mucosal exudates, and edema. Histopathological analysis of multiple biopsy samples revealed over 15 eosinophils per high-power field (hpf) in the proximal squamous mucosa, with no signs of dysplasia. CONCLUSIONS We report a case of EoE development after successful RFA treatment of Barrett's esophagus. This case highlights the importance of long-term endoscopic surveillance in patients with a history of esophageal conditions, even after seemingly successful therapeutic interventions. Clinicians should remain vigilant for atypical presentations of EoE, especially in patients with prior esophageal disease or interventions.