Fibrostenotic complications of eosinophilic esophagitis

Objective. To present clinical case description of complicated eosinophilic esophagitis, including an analysis of disease course features, diagnostic criteria, and approaches to pharmacological and surgical management. Case report. Case of young male (born in 1997) suffering from dysphagia with regular episodes of food impaction in the esophagus are described. Multiple endoscopic studies in the patient medical history did not reveal obvious causes for the episodes of acute obstructive dysphagia; however, in neither case were esophageal biopsies performed or adequate pharmacological therapy initiated. The outcome of a prolonged (7—10 years) active immune-inflammatory process in the esophagus was the development of severe fibrostenotic changes in the esophageal wall, such as rings and strictures with a diameter less than 5 mm. These complications led to severe dysphagia, weight loss, and a marked decrease in quality of life. Pharmacological therapy and balloon dilation of the esophageal strictures helped reduce symptom severity. However, the developed fibrostenotic complications resulted in irreversible remodeling of the esophageal wall in this young man. Conclusion. The presented case underscore the importance of timely disease diagnosis and the initiation of pharmacological therapy to prevent the progression of inflammatory processes and the development of irreversible fibrosclerotic changes in the esophageal wall. In cases where strictures and dysphagia have already developed and do not resolve with pharmacological therapy, patients with eosinophilic esophagitis require endoscopic intervention (balloon dilation or bougienage of the esophagus) to resolve dysphagia and normalize their quality of life.