Gastroenterology: eosinophilic oesophagitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: eosinophilic oesophagitis

Sample item

A 24-year-old man with atopic asthma has had years of dysphagia for solids and a recent episode of meat impaction. Endoscopy shows concentric rings and longitudinal furrows, and biopsies show more than 15 eosinophils per high-power field. Which is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Swallowed topical corticosteroid such as fluticasone or budesonide

Eosinophilic oesophagitis is a chronic antigen-driven oesophageal inflammation in atopic young men, presenting with dysphagia and food impaction. Effective options are proton pump inhibitor therapy, swallowed (not inhaled-and-spat) topical steroids, and dietary elimination, with dilatation for strictures. Surgery for motility disorders or reflux does not treat the eosinophilic inflammation.

Option by option

  • A. Swallowed topical corticosteroid such as fluticasone or budesonide (correct)

    Topical steroids reduce eosinophilic inflammation and relieve dysphagia.

  • B. Laparoscopic fundoplication

    Fundoplication treats reflux, and it is not effective for this allergic oesophagitis.

  • C. Endoscopic botulinum toxin injection

    Botulinum toxin relaxes the lower sphincter in achalasia and does not treat inflammation.

  • D. Heller myotomy

    Heller myotomy treats achalasia, which shows aperistalsis and a bird-beak narrowing, not rings and eosinophils.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Swallowed topical corticosteroid such as fluticasone or budesonide. Eosinophilic oesophagitis is a chronic antigen-driven oesophageal inflammation in atopic young men, presenting with dysphagia and food impaction.

Why is "Laparoscopic fundoplication" not the answer?

Fundoplication treats reflux, and it is not effective for this allergic oesophagitis.

Why is "Endoscopic botulinum toxin injection" not the answer?

Botulinum toxin relaxes the lower sphincter in achalasia and does not treat inflammation.

Why is "Heller myotomy" not the answer?

Heller myotomy treats achalasia, which shows aperistalsis and a bird-beak narrowing, not rings and eosinophils.

What concept does this question test?

It tests Gastroenterology: eosinophilic oesophagitis in General Medicine. Effective options are proton pump inhibitor therapy, swallowed (not inhaled-and-spat) topical steroids, and dietary elimination, with dilatation for strictures. Surgery for motility disorders or reflux does not treat the eosinophilic inflammation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: eosinophilic oesophagitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.