Eosinophilic Esophagitis with Angina Pectoris

Abstract

Eosinophilic esophagitis (EoE) is an immune or antigen-mediated chronic inflammatory esophageal disorder that is relatively rare in Asian countries. The main symptoms of EoE are dysphagia and food impaction. Although chest pain is a symptom of EoE, it is also a symptom of coronary heart disease. This paper reports a case of EoE with angina pectoris in a 45-year-old male who was referred to the authors' hospital for chest pain. He was diagnosed with angina pectoris because of mild stenosis in the left coronary artery on coronary angiography. On the other hand, the symptoms did not improve with angina medication therapy. Therefore, he underwent a chest CT scan, which revealed esophageal thickening. Esophagogastroduodenoscopy was performed. His endoscopic findings showed linear furrows with edema, and >90 eosinophils existed per high-power field on the histology findings. He was diagnosed with EoE. Through additional examinations, he was also diagnosed with asthma. The patient was treated with a proton pump inhibitor and a fluticasone inhaler. His symptoms and abnormal endoscopic findings disappeared after eight weeks of treatment. This case shows that physicians should consider the possibility of the symptoms for EoE when unexplained chest pain persists.

Keywords: Angina pectoris; Chest pain; Eosinophilic esophagitis; Proton pump inhibitors.

Fig. 1

Coronary angiography findings show (A) mild tubular stenosis (40-45%) in the proximal to middle part of the left anterior descending artery (circle) and (B) mild discrete concentric stenosis (30%) in the obtuse marginal branch of the left circumflex artery (circle).

Fig. 2

Chest computed tomography scans show diffuse wall thickening on the (A) middle (arrow) to (B) lower esophagus (arrow).

Fig. 3

Initial state. Endoscopic findings show (A) edematous mucosa and (B) linear furrows were observed in the middle and lower esophagus.(C) Histological findings show chronic active esophagitis with eosinophil infiltration of more than 90 eosinophils per high-power field (H&E, ×400).

Fig. 4

After eight weeks of treatment. (A) Endoscopic finding shows the disappearance of linear furrows and edematous mucosa. (B) Histopathologic examination shows a marked decrease in eosinophil counts of less than five eosinophils per high-power field (H&E, ×200).