Paeds Cases · gastroenterology-hepatology-and-nutrition
Dysphagia and oesophageal disorders — structured clinical encounter
Structured encounter testing the approach to a teenager with a food bolus impaction, solid-food dysphagia and atopy: the recognition and diagnosis of eosinophilic oesophagitis with biopsy at the impaction endoscopy, the exclusion of mimics, the first-line treatment ladder and the role of dupilumab and dilation, the monitoring to histological remission, and the conversation with the family about a chronic relapsing condition.
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Station 1 — the emergency and the diagnosis
Asked for my first impression, I explain that this is a food bolus impaction needing urgent endoscopic disimpaction, and that in a teenager with atopy and a year of adaptive eating the impaction is almost certainly the first presentation of eosinophilic oesophagitis. I would keep him nil by mouth and arrange endoscopy, taking oesophageal biopsies at the same procedure even if the mucosa looked near-normal. [16] [1]
References16ShowHide
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