Symptoms of eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) can overlap, and proton pump inhibitors (PPIs) are often started empirically for esophageal symptoms. Despite guideline recommendations to perform endoscopy off PPI therapy, endoscopy in clinical practice is commonly performed while patients are on PPIs which can mask endoscopic findings of EoE and GERD and obscure the diagnosis. This case highlights the importance of discontinuing PPI therapy before endoscopy to optimize the diagnostic yield for EoE and GERD, while demonstrating the significant potential consequences of a missed diagnosis.
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