Eosinophilic oesophagitis — ESEGH MCQ
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Correct answer: B — Eosinophilic oesophagitis
The diagnosis is eosinophilic oesophagitis. The combination of intermittent dysphagia, recurrent food bolus obstruction, atopic disease, oesophageal rings and longitudinal furrows is characteristic. The biopsy count also clearly exceeds the accepted diagnostic threshold of at least 15 eosinophils per 0.3 mm², in the appropriate clinical context. Diffuse oesophageal spasm may cause intermittent dysphagia but does not produce these endoscopic or histological findings. Candidiasis typically causes adherent white plaques, often with odynophagia or immunosuppression. Barrett's oesophagus is columnar metaplasia associated with reflux, while Plummer-Vinson syndrome classically involves iron-deficiency anaemia and a proximal oesophageal web. Oesophageal biopsies should be obtained when eosinophilic oesophagitis is suspected, even if endoscopic abnormalities are subtle or absent.
Reference: Dhar A, et al. British Society of Gastroenterology and BSPGHAN joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults, section on definition and diagnosis. Gut. 2022;71:1459–1487. https://gut.bmj.com/content/71/8/1459