Long-term follow-up of a patient with eosinophilic oesophagitis

Abstract

A young man with complaints of dysphagia and heartburn had the diagnosis of eosinophilic oesophagitis verified at the age of 21 based on a typical endoscopic picture (transverse rings, oesophageal stricture) and histological examination (significant eosinophilic infiltration of the oesophageal mucosa). According to his medical history, at the age of 7 the patient was diagnosed with bronchial asthma, atopic dermatitis, food allergy, the manifestation of eosinophilic oesophagitis also occurred in childhood, and at the age of 14 an oesophageal stricture was found. Initial treatment with fluticasone and proton pump inhibitors resulted in achievement of clinical, endoscopic and histological remission. The article presents the dynamic course of eosinophilic oesophagitis over a 4-year period; the patient’s refusal of medication or withdrawal of fluticasone, quitting of the elimination diet was followed by clinical or histological worsening. Marked histological changes in the oesophageal mucosa might have not been accompanied by complaints of dysphagia neither a typical endoscopic picture could be observed. Maintenance therapy with topical steroids should be administered for a long period, and histological remission is an important criterion of its effectiveness. Key words: eosinophilic oesophagitis, fluticasone, topical steroids, proton pump inhibitor, remission