Drug Concentration Monitoring in
Preventive Care in Patients with
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An 87-Year-Old Woman
With Recurrent Dysphagia
Published previously in Gastroenterology (2016;151:1085-6)
By Roald F. Havre, MD, PhD, Trine Hallager,
and Evangelos Kalaitzakis, MD
Dr. Havre and Dr. Kalaitzakis are in the Endoscopy Unit of Copenhagen
University Hospital/Herlev, University of Copenhagen. Ms. Hallager is in
the department of pathology, Copenhagen University Hospital/Herlev. The
authors disclose no conflicts.
An 87-year-old woman was referred for dysphagia that had been present for several years. Three years prior to this presentation she had undergone an esophagogastroduo- denoscopy (EGD) on the same in- dication showing a proximal and a distal esophageal benign-appearing
stricture but no signs of esophagitis. Both were
dilated and biopsied. Histopathology showed
infiltration with lymphocytes and neutrophilic
granulocytes, and superficially fungal hyphae
and spores. No predominance of eosinophilic granulocytes was noted.
A proton-pump inhibitor was prescribed, and she was scheduled for
a control gastroscopy, but was lost to follow-up. She was otherwise
healthy without any allergies.
Upon re-presentation, she was under treatment with pantoprazole 40
mg OD. Upon EGD a spiral-shaped proximal esophageal stricture with
normal-appearing mucosa only passable with a nasal endoscope was observed. The rest of the esophagus was seen with mucosal concentric rings
(Figure A). The esophageal mucosa was otherwise endoscopically normal
throughout. Biopsies were taken from the distal and proximal esophagus.
Balloon dilation of the proximal stricture was performed (CRE, Boston
Scientific) to 13. 5 mm. Subsequently, a standard gastroscope could be
passed to the duodenum revealing normal-appearing gastric and duodenal mucosa.
What is the diagnosis?
A. Eosinophilic esophagitis
B. Reflux-associated esophagitis with stenosis
C. Lymphocytic esophagitis