Gastroenterology

	Answer 2 Esophageal biopsy. The patient’s esophagus should be biopsied to confirm the suspected diagnosis of eosinophilic esophagitis. A high concentration (< 15-20) of eosinophils per high-power field is characteristic of eosinophilic esophagitis.1 Observation alone would be inadequate given this patient’s ongoing symptoms. There is no mechanical obstruction and therefore dilation would not be helpful. PPI therapy could be started, but the underlying disease process is not due to acid exposure. Fluconazole is a treatment for candidiasis, which this patient does not appear to have. REFERENCES 1. Baxi S, Gupta SK, Swigonski N, Fitzgerald JF. Clinical presentation of patients with eosinophilic inflammation of the esophagus. Gastrointest Endosc 2006;64:473–8. Click here to return to the questions
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