Inflammatory synergy: a rare encounter of eosinophilic esophagitis and acute gastritis

Eosinophilic Esophagitis (EoE) is a chronic, antigen-mediated esophageal disease characterized by eosinophil-predominant inflammation, typically identified in younger individuals, particularly white males between 30 and 40 years of age. However, this case report discusses an unusual presentation of EoE in a 65-year-old female with a history of allergic rhinitis. The patient presented with symptoms of heartburn, epigastric pain, dysphagia, nausea, vomiting, and abdominal bloating, which had been occurring intermittently over the past two years. Investigations revealed significant eosinophilia, with 20% eosinophils in the differential count and a high erythrocyte sedimentation rate (ESR) of 34 mm/hr. Endoscopy demonstrated feline esophagus with unhealthy mucosa in the lower esophagus and an inflamed, edematous antrum. Biopsies confirmed the diagnosis of EoE with 18 eosinophils per high-power field. This case highlights the importance of considering EoE in elderly patients presenting with gastrointestinal symptoms, particularly in those with a history of atopic conditions. Early diagnosis and treatment are crucial in managing symptoms and preventing complications.