Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave's syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children) and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

Spontaneous Intramural Esophageal Rupture: An Uncommon Presentation of Eosinophilic Esophagitis Requiring Endoscopic Clipping

“… 11 Complications related to EoE include strictures, food impaction, and secondary gastroesophageal reflux disease, but tears, lacerations, and perforations are rarely reported. 12 Mucosal tears or lacerations during endoscopic dilation of narrowed segments are suggestive of increased mucosal fragility from chronic inflammation and eosinophilic infiltration, with subsequent remodeling described as “crepe paper sign.” 1 , 2 , 8 , 10 Our patient had no history of atopy or episodes of dysphagia/food impaction, which commonly occur in EoE. However, he had chronic, intermittent symptoms of heart burn, which is the predominant symptom (75%) in EoE.…”

From eosinophilic esophagitis to esophagus perforation: clinical management strategies

“…In the case of ineffectiveness of the first line treatments, the formed constrictions are expanded mechanically by means of an endoscopic balloon, the common complication of which is esophageal perforation [3][4][5]. Studies have shown that 31% of EoE patients have complications, from which 19% present vertical mucosal lacerations, 8% esophageal perforation with pneumomediastinum, and only 3% Boerhaave's syndrome [10,11]. Differential diagnosis of EoE and GERD, achalasia, Crohn disease, hypereosinophilic syndrome, pill esophagitis or infectious esophagitis is important [12].…”

Strategies of the treatment of spontaneous esophageal rupture: Report of thirteen cases from Xingtai, Hebei Province, China

“…The number of patients with vomiting accounted for 84.6% of the total number of patients, consistent with the literature reported proposal. 3 The etiological factors associated with this disease is still not clear at present but, reports from previously conducted studies states that eosinophilic esophagitis is one of the causes of spontaneous esophageal rupture 4,5 and states that eosinophilic esophagitis is a transmural disease, spontaneous esophageal rupture is a serious complication of eosinophilic esophagitis. Some of the studies reported it as anti-phospholipid antibody syndrome which can cause the disease recurrently.…”