Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-Adult Case Studies and Debates

Adult Case Studies and Debates

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This document presents a series of detailed adult case studies focused on esophageal disorders causing dysphagia and related symptoms, emphasizing clinical evaluation, diagnosis, and management strategies.<br /><br />Case 1 describes a 34-year-old male with intermittent solid food dysphagia and GERD symptoms. Esophagogastroduodenoscopy (EGD) with biopsy revealed eosinophilic esophagitis (EoE), confirmed by mucosal eosinophil infiltration (>15 eosinophils/high-power field). Initial treatment with twice-daily proton pump inhibitors (PPIs) showed mild improvement, leading to topical steroid therapy and dietary elimination. Esophageal dilation may be considered for persistent symptoms but does not address inflammation.<br /><br />Case 2 involves a 50-year-old female with progressive dysphagia to solids and liquids, regurgitation, and a dilated esophagus on barium swallow. High-resolution manometry confirmed type II achalasia, characterized by impaired lower esophageal sphincter (LES) relaxation and absent peristalsis. Treatment options include pneumatic dilation, laparoscopic myotomy (Heller myotomy), or peroral endoscopic myotomy (POEM), with efficacy varying by achalasia subtype.<br /><br />Case 3 discusses a 42-year-old female with refractory gastroesophageal reflux disease (GERD) symptoms despite twice-daily PPI therapy. Barium esophagram and 48-hour Bravo pH monitoring confirmed pathological acid reflux. Management includes optimizing PPI therapy, lifestyle modification, possible surgical fundoplication, and esophageal impedance-pH monitoring. Alternative treatments like potassium-competitive acid blockers or neuromodulators may be considered for refractory cases.<br /><br />Case 4 covers acute onset odynophagia and dysphagia in a 74-year-old female, with pill esophagitis identified due to potassium supplementation. Management includes discontinuing offending agents, hydration, and symptomatic care.<br /><br />Case 5 presents a 56-year-old male with progressive solid food dysphagia and significant weight loss. EGD and biopsy diagnosed esophageal adenocarcinoma, often linked to GERD and Barrett’s esophagus. Staging involves CT, PET, and endoscopic ultrasound (EUS). Treatment depends on stage and may include surgery, chemotherapy, or palliative measures.<br /><br />Overall, the cases illustrate diagnostic approaches including history, imaging (barium swallow, CT, PET), endoscopy with biopsy, motility studies, and highlight the importance of personalized treatment informed by disease etiology, severity, and patient factors.

Keywords

esophageal disorders

dysphagia

eosinophilic esophagitis

achalasia

gastroesophageal reflux disease

pill esophagitis

esophageal adenocarcinoma

esophagogastroduodenoscopy

high-resolution manometry

proton pump inhibitors