Eosinophilic esophagitis with a severe stenosis: report of a Japanese case
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CASE REPORT
Eosinophilic esophagitis with a severe stenosis: report of a Japanese case Yosuke Toya1 · Tomo Kumei1 · Shun Yamada1 · Risaburo Akasaka1 · Shunichi Yanai1 · Shotaro Nakamura1 · Mitsumasa Osakabe2 · Noriyuki Uesugi2 · Tamotsu Sugai2 · Takayuki Matsumoto1 Received: 28 April 2020 / Accepted: 1 June 2020 © Japanese Society of Gastroenterology 2020
Abstract A 49 years old male, who had had postprandial dysphagia during the preceding 10 years, was referred to our hospital. Esophagogastroduodenoscopy (EGD) revealed longitudinal furrows and concentric rings in the mid to lower esophagus and stenosis in the lower esophagus. Histologic findings from esophageal biopsies showed eosinophilic infiltration (> 15 per high-power field). Under a diagnosis of eosinophilic esophagitis, an endoscopic bougie was performed, which resulted in symptomatic relief. Follow-up EGD revealed that the stenosis had improved, but histologic findings of eosinophilic esophagitis were remaining. Our case suggests that although rare, esophageal stenosis occurs in Japanese patients with EoE, and that the complication may be a consequence of prolonged disease. Other risks and the appropriate treatment for the prevention of stenosis need to be elucidated further. Keywords Eosinophilic esophagitis · Stenosis · Disease duration
Introduction Eosinophilic esophagitis (EoE) is a chronic, immune- or antigen-mediated inflammatory esophageal disease, characterized by symptoms related to esophageal dysfunction and dense eosinophilic infiltration [1]. Reports from Western countries have shown that the prevalence of EoE has been increasing during the past decades [2, 3]. As well as in Western countries, cases of EoE have been reported increasingly in Asian countries including Japan. The food impaction due to esophageal strictures is one of the major symptoms of EoE in Western countries. However, most of the Asian literatures have shown less progressive disease, and food impaction has been reported to be extremely rare in Asian EoE cases when compared to Western countries [4, 5]. Herein, we report a Japanese case of * Yosuke Toya ytoya@iwate‑med.ac.jp 1
Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1‑1‑1, Yahaba 028‑3694, Japan
Division of Molecular Diagnostic Pathology, Department of Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
2
EoE accompanied by severe stenosis together with a review of EoE patients diagnosed at our institution.
Case report A 49 years-old male was referred to our hospital for detailed examination of esophageal stenosis. He first complained of esophageal impaction of ingested meat at the age of 35 years, and since then he repeatedly experienced dysphagia. He again experienced impaction of meat two weeks previously and visited his neighboring clinic, where a diagnosis of esophageal cancer was suspected. During the 10-year period, he did not experience symptoms suggestive of gastro-esophageal reflux disease (GERD), such as h
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