Recurrent Dysphagia Beyond the Usual Diagnoses: A Case of Fibrostenotic Eosinophilic Esophagitis in an Adult

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease and an increasingly recognized cause of dysphagia in adults. Diagnostic delay remains frequent and is associated with progression toward fibrostenotic disease and esophageal strictures. Case Presentation: We report the case of a 38-year-old man presenting with long-standing progressive dysphagia, initially attributed to other causes. Upper gastrointestinal endoscopy revealed a tight distal esophageal stenosis. Initial biopsies were non-diagnostic, and the patient underwent repeated endoscopic dilations with only transient improvement. Systematic esophageal biopsies obtained during reassessment demonstrated marked eosinophilic infiltration consistent with eosinophilic esophagitis. A diagnosis of fibrostenotic EoE was established. The patient was treated with a combined strategy including progressive esophageal dilation and anti-inflammatory medical therapy with topical corticosteroids, followed by orodispersible budesonide. This approach resulted in sustained clinical improvement, increased esophageal caliber, and histological remission under maintenance therapy. Conclusion: This case highlights the consequences of delayed diagnosis of eosinophilic esophagitis in adults and underscores the importance of systematic esophageal biopsies in patients with unexplained dysphagia. In fibrostenotic EoE, combined anti-inflammatory therapy and endoscopic dilation are essential to achieve durable symptom control and prevent disease progression.