A Cricopharyngeal Bar as an Underrecognized Finding in an Adolescent with Eosinophilic Esophagitis

Abstract

A 16-year-old Caucasian male with previously diagnosed eosinophilic esophagitis (EoE) 4 years before his initial visit to an allergist-immunologist, scheduled due to severe dysphagia and recurrent food impaction. He had been off EoE therapy for 1 year. After resuming inhaled fluticasone and a proton pump inhibitor (PPI), esophagogastroduodenoscopy (EGD) was immediately scheduled. The dates of the original EGD procedures with the histological summary and EoE therapy are reported in the Table 1. The fourth endoscopy revealed near normal histology, with rare candida staining (Table 1). He was continued on daily PPI and the fluticasone was discontinued. Three weeks of Fluconazole failed to resolve his dysphagia. A repeat barium swallow confirmed a pre-existing cricopharyngeal bar, and he was referred to an otolaryngology for further care.

Table 1.

Date	Proximal eosinophils/HPF	Mid eosinophils/HPF	Distal eosinophils/HPF	Therapy
2019 (first)	30	30	15	None
2019 (second)	70	60	100	PPI
2019 (third)	80	100	100	Swallowed budesonide 1 mg BID + PPI
2023 (fourth)	3	N/D	5	PPI + 220 µg of Fluticasone

PPI, proton pump inhibitor.