Eosinophilic Esophagitis (Eoe) Following Bioenteric Intragastric Balloon (BIB) Insertion

A 24 years old female obese patient with BMI 38kg/ m2, presented for weight control through endoscopic bioenteric intra gastric balloon (BIB) insertion. She had irrelevant past medical history with no history of atopy. Following the insertion of BIB, she experienced epigastric pain and vomiting for the first couple of weeks. After 6 months of BIB insertion she started to develop progressive dysphagia of 2 months duration. Upper endoscopy was done with the decision to remove the balloon; it showed multiple mucosal ridges, furrows and corrugations with whitish exudate over it in the distal two thirds of the esophagus as shown in figure (1). Multiple biopsies were taken showing stratified squamous esophageal mucosa with marked basal cell hyperplasia and wide exudation of eosinophils (>15/HPF), together with few mononuclear cells and polymorphs with no neoplasia or dysplasia. After diagnosing the patient with eosinophilic esophagitis, inhaled corticosteroids in the form of fluticasone was prescribed to her together with the high dose of proton pump inhibitors (PPI) that she was already taking due to reflux symptoms following BIB insertion. After removal of the BIB her symptoms were markedly improved and the symptoms did not recur.