A Diagnosis Diffi cult to Swallow

Dysphagia with a normal endoscopy presents a challenge in diagnosis. While encountering such cases, the clinicians should remember the following points:

Dysphagia with a normal endoscopy should prompt consideration of eosinophilic esophagitis (EOE) as a potential differential diagnosis.

Conduct esophageal biopsies for all patients presenting with dysphagia, especially when the endoscopy appears normal.

EOE has the potential to mimic motility disorders during high-resolution manometry testing.  Skin lesions are an important clue in the diagnosis. 

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