Acute intramucosal dissection of the esophagus (IED) is a rare complication of eosinophilic esophagitis (EoE). Only few of such IED cases have been described in the literature. We report the case of a 32-year-old man with a 4-months diagnosis of EoE who was referred to the Emergency Department complaining of dysphagia, epigastric pain and fever and who was diagnosed, after an urgent endoscopy, an IED. After careful evaluation and multidisciplinary assessment the patient was managed conservatively, with specific medical therapy—high-dose proton pump inhibitors, swallowed steroid, broad-spectrum antibiotic—and, after a period of absolute fasting, a diet regimen based on “six food elimination diet” with a stepwise increase of food consistency. The patient experienced a rapid and complete relief of symptoms, paralleled by a progressive healing of IED with no recurrence over a 6-month follow-up period. In EoE patients with a high clinical suspicion of an acute IED, we suggest an early execution of chest CT and a contrast esophagography, avoiding potentially dangerous endoscopic procedures in the acute phase that can contribute to enlargement of the dissection, or progression to perforation. Once the diagnosis of IED is confirmed, even in the presence of a contained perforation, a conservative treatment with a multidisciplinary management should always be considered.

Fianchi, F., De Matteis, G., Cianci, R., Pizzoferrato, M., Cardone, S., Nicolazzi, M. A., Fuorlo, M., Congedo, M. T., Arena, V., Riccioni, M. E., Barbaro, B., Gambassi, G., Acute intramucosal dissection in eosinophilic esophagitis, <<CLINICAL JOURNAL OF GASTROENTEROLOGY>>, 2019; 12 (6): 525-529. [doi:10.1007/s12328-019-00990-y] [https://hdl.handle.net/10807/270606]

Acute intramucosal dissection in eosinophilic esophagitis

De Matteis, Giuseppe
Secondo
;
Cianci, Rossella;Congedo, Maria Teresa;Arena, Vincenzo;Riccioni, Maria Elena;Barbaro, Brunella;Gambassi, Giovanni
Ultimo
2019

Abstract

Acute intramucosal dissection of the esophagus (IED) is a rare complication of eosinophilic esophagitis (EoE). Only few of such IED cases have been described in the literature. We report the case of a 32-year-old man with a 4-months diagnosis of EoE who was referred to the Emergency Department complaining of dysphagia, epigastric pain and fever and who was diagnosed, after an urgent endoscopy, an IED. After careful evaluation and multidisciplinary assessment the patient was managed conservatively, with specific medical therapy—high-dose proton pump inhibitors, swallowed steroid, broad-spectrum antibiotic—and, after a period of absolute fasting, a diet regimen based on “six food elimination diet” with a stepwise increase of food consistency. The patient experienced a rapid and complete relief of symptoms, paralleled by a progressive healing of IED with no recurrence over a 6-month follow-up period. In EoE patients with a high clinical suspicion of an acute IED, we suggest an early execution of chest CT and a contrast esophagography, avoiding potentially dangerous endoscopic procedures in the acute phase that can contribute to enlargement of the dissection, or progression to perforation. Once the diagnosis of IED is confirmed, even in the presence of a contained perforation, a conservative treatment with a multidisciplinary management should always be considered.
2019
Inglese
Fianchi, F., De Matteis, G., Cianci, R., Pizzoferrato, M., Cardone, S., Nicolazzi, M. A., Fuorlo, M., Congedo, M. T., Arena, V., Riccioni, M. E., Barbaro, B., Gambassi, G., Acute intramucosal dissection in eosinophilic esophagitis, <<CLINICAL JOURNAL OF GASTROENTEROLOGY>>, 2019; 12 (6): 525-529. [doi:10.1007/s12328-019-00990-y] [https://hdl.handle.net/10807/270606]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/270606
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 4
social impact