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Eosinophilic Esophagitis Causing Esophageal Dysmotility

We describe a case of eosinophilic esophagitis in a 38- year-old man with aspirin-sensitivity asthma which presented as noncardiac chest pain. Manometric mea­surements demonstrated tertiary contractions. Biopsies showed a dense eosinophilic infiltrate in the mucosa. There was no response to therapy for reflux. Symptoms quickly resolved with corticosteroid therapy. Subsequent manometric values recorded after corticosteroid therapy showed resolution of the dysmotility. Biopsies showed normal mucosa. Adult asthmatic subjects with noncardiac chest pain should receive further investigation if reflux therapy fails to resolve the symptoms.

The most common esophageal symptoms in asthmatic subjects are due to gastroesophageal reflux. Reflux may worsen the asthma, and control of the asthma may not occur until the reflux is adequately managed. Many medications used to treat asthma decrease lower esophageal sphincter tone. This may contribute to the reflux symptoms. Therefore, reflux is commonly seen in both children and adults with asthma, both as a cause of the asthma and as a consequence of treatment.

In this case report, we describe an asthmatic patient with a long history of reflux who develops a new chest pain syndrome related to, but distinct from, the reflux. Initial attempts to manage the reflux did not decrease the pain. A  diagnosis of dysmotility was made by esophageal manometric measurements. Mucosal biopsy demonstrated eosinophilic esophagitis. The patient promptly responded to corticosteroid treatment. 

Case Report

A 38-year-old man with asthma was seen for a 1-month history of atypical chest pain. The pain was substemal, squeezing, and did not radiate. The pain often awoke the patient at night. Sometimes the pain was preceded by heartburn. It was partially relieved by antacids and swallowing cold liquids. The episodes of pain would last from 15 min to several hours. There was no shortness of breath or diaphoresis. There was no exertional component. The chest pain was preceded by a 2-week history of increased nasal discharge. There were no new medications, new foods, or changes in diet.