A 61-year-old woman without any significant past medical history,
presented to the clinic with 3 months of heartburn, dysphagia, and recent
regurgitation of food. She had taken antacids and acid suppressive therapy
without improvement of her symptoms. She denied weight loss, melena, or
nonsteroidal anti-inflammatory use. Her physical exam, including vitals and
abdominal exam, was normal. Laboratory data including a complete blood count,
and comprehensive metabolic panel, were all unremarkable. An upper endoscopy
demonstrated multiple sessile polyps < 5 mm in diameter in the
upper two-thirds of the esophagus, all of which were removed with cold forceps
([Fig. 1]). Linear furrows were also noted
throughout the esophagus. ([Fig. 2]). The rest of
the upper gastrointestinal tract was normal. Histological examination of the
esophageal polyps revealed polypoid squamous mucosa with increased numbers of
intraepithelial lymphocytes and > 70 eosinophils per high power field
([Fig. 3]). The patient was subsequently placed on
fluticasone, and on follow up all of her symptoms had resolved.
Fig. 1 Esophageal polyp and
furrows.
Fig. 2 Esophageal polyps with
linear furrows.
Fig. 3 Abundance of
eosinophils.
Eosinophilic esophagitis, first described in the 1970s, is
characterized by > 15 eosinophils per high power field in concordance
with symptoms of heartburn, regurgitation, dysphagia, or food bolus impactions
[1]. The etiology is unknown but its strong association
with atopic diseases such as food allergy, asthma, and eczema suggest an
allergic pathway. Strictures are sometimes present, and typical endoscopic
features described include horizontal rings, linear furrows, whitish exudates,
granularity, and ulceration. Treatment options include elimination diets,
inhaled or swallowed steroids, and other anti-inflammatory medications.
Esophageal dilation must be done with great care, as perforation rates are
probably higher in this population than with peptic or malignant strictures
[2].
Our case had a unique endoscopic finding of esophageal polyps in the
context of eosinophilic esophagitis. This is a rare finding, which has mostly
been described in the pediatric literature [3]. There is
no evidence to suggest that these polyps are premalignant; however, this case
should heighten awareness of the association of eosinophilic esophagitis with
polyps of the esophagus.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH
