Título De Especialista Em Gastroenterologia (FBG) Practice Questions - Título De Especialista Em Gastroenterologia - Federação Brasileira De Gastroenterologia (FBG AMB) Exam

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A 26-year-old atopic male presents with intermittent solid-food dysphagia and an episode of food impaction requiring endoscopic meat bolus extraction. Endoscopy reveals circular esophageal rings ('trachealization'), linear furrows, and white exudative plaques. Esophageal mucosal biopsies show 25 eosinophils per high-power field (HPF). What is the first-line management protocol for this patient?

High-dose proton pump inhibitor (PPI) therapy or swallowed topical corticosteroids (fluticasone/budesonide) or an empiric food elimination diet. Immediate pneumatic balloon dilation to 35 mm to disrupt the muscularis propria. Continuous oral systemic prednisone 60 mg/day for 12 months as maintenance therapy. Subtotal esophagectomy with gastric pull-up due to high risk of transmural perforation.

Correct Answer:

High-dose proton pump inhibitor (PPI) therapy or swallowed topical corticosteroids (fluticasone/budesonide) or an empiric food elimination diet.

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