Eosinophilic esophagitis in an octogenarian: A case report and review of the literature

Eosinophilic esophagitis manifesting as intractable hiccups in an elderly patient: a case report

BACKGROUND

Eosinophilic esophagitis is a condition characterized clinically by symptoms related to esophageal dysfunction and histologically by a marked eosinophilic infiltrate in the esophageal mucosa. The most typical symptoms of eosinophilic esophagitis include intermittent dysphagia with episodic food impaction and heartburn with propensity for young individuals. The relationship between hiccups and eosinophilic esophagitis is unclear but has been described.

CASE REPORT

We report a case of a 93-year-old Middle Eastern male presenting for longstanding treatment-refractory hiccups. Imaging with computed tomography of the chest and abdomen was unremarkable. An upper endoscopy was normal without any endoscopic finding to suggest eosinophilic esophagitis. Given his elevated peripheral eosinophil count, biopsies were taken from mid- and distal esophagus and revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field, favoring a diagnosis of eosinophilic esophagitis. The hiccups resolved following the initiation of eosinophilic esophagitis treatment.

CONCLUSION

This case underscores the need to consider the diagnosis of eosinophilic esophagitis in the setting of chronic refractory hiccups.

Eosinophilic Esophagitis in the Setting of Prior Caustic Ingestion

A seven-year-old male presented with complaints of food refusal, dysphagia, and odynophagia for three weeks. He also had a history of caustic ingestion six months prior to the presentation. Diagnostic esophagogastroduodenoscopy (EGD) revealed post-burn esophageal stricture, and biopsy confirmed eosinophilic esophagitis (EoE). In this report, we discuss the diagnosis and management of these pathologies. We suspect that the damage sustained from caustic ingestion laid the groundwork for the development of EoE in this patient.

Eosinophilic Esophagitis

Eosinophilic esophagitis is an immune-mediated chronic disease of the esophagus. It is clinically characterized by symptoms related to esophageal dysfunction and histologically by eosinophil-rich inflammation with a peak intraepithelial eosinophil count of at least 15 eosinophils per high-power field. Both children and adults can be affected with a strong male predominance. Food appears to be the key trigger, although the exact mechanisms remain unclear. Treatment for eosinophilic esophagitis can be summarized as the 3 D's: dietary, drugs, and dilatation. The differential diagnosis includes gastroesophageal reflux disease, eosinophilic gastroenteritis, drug hypersensitivity, hypereosinophilic syndrome, infection, Crohn disease, connective tissue diseases, and vasculitis.

Demographic Features of Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is an increasingly prevalent chronic condition characterized by eosinophilic infiltration of the esophageal epithelium accompanied by esophageal symptoms. The number of new diagnoses is growing worldwide in both pediatric and adult populations. Differences in disease distribution and presentation have been found, varying by gender, race, and other characteristics. This review examines the existing literature and provides insight into the demographic features of EoE.