University of California San Francisco San Francisco, CA, United States
Alexis M. Bayudan, MD, Aparajita Singh, MD University of California San Francisco, San Francisco, CA
Introduction: We present an unusual case of eosinophilic esophagitis diagnosed in a 57 year old man following a history of radiation therapy for oropharyngeal cancer. Lack of prior symptoms and the temporal association raise a possibility whether radiation could be a trigger of his eosinophilic esophagitis as it is rarely reported in the literature.
Case Description/Methods: 57 year old man who was previously in good health developed poorly differentiated metastatic squamous cell carcinoma of the oropharynx. He was treated with radiation therapy and chemotherapy containing cisplatin in 2014. Three years after his radiation therapy he developed solid food dysphagia and intermittent mild food impaction episodes that self-resolved.
We suspected chronic radiation related esophageal stricture. His upper endoscopy revealed no esophageal stricture, but rather multiple linear furrows and rings were noted. Midesophageal biopsies demonstrated eosinophilic esophagitis with >100 eosinophils/hpf.
Interestingly, he denied any symptoms of dysphagia or any esophageal symptoms prior to his radiation therapy and cancer diagnosis at age 50. He did not have predisposing factors found in patients with eosinophilic esophagitis, such as asthma or environmental allergies, commonly seen in children and younger adults.
He had improvement in symptoms on pantoprazole 40mg twice daily and fluticasone 220 mcg , 2 puffs swallowed twice daily for a month. His repeat EGD 3 months later demonstrated marked improvement in the linear furrows and almost resolution of the rings. Esophageal biopsies demonstrated peak of 47 eosinophils/hpf. Since he had significant improvement in his dysphagia, he has chosen to stop his fluticasone therapy and continues on pantoprazole 40mg once daily with excellent control of symptoms.
Discussion: We present this very interesting case, as eosinophilic esophagitis is typically not considered in the differential diagnosis in the post-radiation dysphagia work up. We noted a published case report of simultaneous eosinophilic esophagitis complicating a case of radiation induced esophageal strictures. It is important to consider this diagnosis in patients with radiation esophagitis with suspicion for eosinophilic esophagitis as they should undergo cautious dilation. Despite normal endoscopic appearance, biopsies should be considered to rule out eosinophilic esophagitis even in older adults with history of radiation exposure.
Figure: Linear furrows and esophageal rings consistent with eosinophilic esophagitis.
Disclosures: Alexis Bayudan indicated no relevant financial relationships. Aparajita Singh indicated no relevant financial relationships.
Alexis M. Bayudan, MD, Aparajita Singh, MD. P0353 - Eosinophilic Esophagitis: An Unusual Cause of Dysphagia After Radiation Therapy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
