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A case of a “fragile” oesophagus
  1. G K Anagnostopoulos,
  2. T Shonde,
  3. P Kaye,
  4. K Ragunath
  1. Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK
  1. Correspondence to:
    Dr G K Anagnostopoulos
    Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK; george.anagnostopoulos{at}nottingham.ac.uk

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Clinical presentation

A 25 year old man with no allergic history underwent gastroscopy due to longstanding dysphagia. Six months previously he had an episode of food bolus obstruction. He had undergone gastroscopy which had shown no abnormal findings. pH/manometry studies were recommended and were also normal. During intubation and scope insertion, the macroscopic appearance of oesophagus was normal. No strictures were observed and there was no evidence of oesophagitis, Barrett’s oesophagus, or hiatus hernia. The rest of the endoscopy was also unremarkable. On withdrawing the endoscope, we noticed a large bleeding mucosal tear at 25 cm from the incisors (fig 1A). Biopsies were obtained from the oesophagogastric junction and mid-oesophagus (fig 1B).

Figure 1

 A mucosal tear in the upper-mid oesophagus.

Figure 2

 Histology demonstrated eosinophilic infiltration of the oesophagus with >40 eosinophils/high power field.

Question

What is the diagnosis?

See page 1511 for answer

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  • Robin Spiller, Editor

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