Acute intramucosal dissection in eosinophilic esophagitis
| Autor: | Maria Teresa Congedo, Silvia Cardone, Francesca Fianchi, Giovanni Gambassi, Vincenzo Arena, Marco Pizzoferrato, Mariella Fuorlo, Maria Anna Nicolazzi, Brunella Barbaro, Rossella Cianci, Maria Elena Riccioni, Giuseppe De Matteis |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Perforation (oil well) Conservative Treatment 03 medical and health sciences 0302 clinical medicine Elimination diet medicine Humans Esophagus Eosinophilic esophagitis Esophageal Perforation business.industry Gastroenterology Proton Pump Inhibitors General Medicine Emergency department Eosinophilic Esophagitis Fasting medicine.disease Dysphagia Surgery Anti-Bacterial Agents Regimen Dissection medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Acute Disease 030211 gastroenterology & hepatology Drug Therapy Combination Steroids medicine.symptom business Deglutition Disorders |
| Zdroj: | Clinical journal of gastroenterology. 12(6) |
| ISSN: | 1865-7265 |
| Popis: | Acute intramucosal dissection of the esophagus (IED) is a rare complication of eosinophilic esophagitis (EoE). Only few of such IED cases have been described in the literature. We report the case of a 32-year-old man with a 4-months diagnosis of EoE who was referred to the Emergency Department complaining of dysphagia, epigastric pain and fever and who was diagnosed, after an urgent endoscopy, an IED. After careful evaluation and multidisciplinary assessment the patient was managed conservatively, with specific medical therapy—high-dose proton pump inhibitors, swallowed steroid, broad-spectrum antibiotic—and, after a period of absolute fasting, a diet regimen based on “six food elimination diet” with a stepwise increase of food consistency. The patient experienced a rapid and complete relief of symptoms, paralleled by a progressive healing of IED with no recurrence over a 6-month follow-up period. In EoE patients with a high clinical suspicion of an acute IED, we suggest an early execution of chest CT and a contrast esophagography, avoiding potentially dangerous endoscopic procedures in the acute phase that can contribute to enlargement of the dissection, or progression to perforation. Once the diagnosis of IED is confirmed, even in the presence of a contained perforation, a conservative treatment with a multidisciplinary management should always be considered. |
| Databáze: | OpenAIRE |
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