Esophageal Rings, Furrows, and Plaques: What Next?

These endoscopic findings help explain worsening dysphagia in a 32-year-old man. Esophageal biopsies prove positive for eosinophilia. How would you proceed?

A 32-year-old man presents with dysphagia to solid foods. His symptoms have increased in frequency during the past 6 months. He has taken to eating much more slowly and needs water to help swallow food. His history is remarkable for seasonal allergies, for which nasal fluticasone is prescribed. He undergoes an upper endoscopy, which demonstrates diffuse rings, longitudinal furrows, and white plaques. Esophageal biopsies reveal dense eosinophilia throughout.

What is your next step in management?

A. Start swallowed topical corticosteroids
B. Refer to allergist for skin prick testing
C. Begin treatment with an acid suppressant
D. Perform esophageal dilatation
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