eosinophilic esophagitis ( eoe ) is a commonly recognized pediatric condition that has emerged as a disorder increasingly affecting adults .
although eoe has been documented in all ages , races and genders , the typical eoe patient is an adult male with prior history of atopy .
eoe is characterized by chronic , immune / antigen - mediated esophageal dysfunction with eosinophil - predominant inflammation .
incidence rates of eoe have increased over the past decade beyond what would be expected by increased recognition alone [ 1 , 2 ] .
food impaction , chest pain , upper abdominal pain , symptoms of gastroesophageal reflux disease ( gerd ) and globus have also been reported in some adults with eoe [ 5 , 6 ] .
new consensus recommendations released in 2011 established a minimum peak value of 15 eosinophils / hpf as a requirement for a diagnosis of eoe with few exceptions .
additionally , due to an increasing prevalence of proton pump inhibitor - responsive esophageal eosinophilia , therapeutic trials of proton pump inhibitor or ph monitoring were recommended to aid in distinguishing eoe from gerd .
studies have demonstrated both clinical and histologic response to ( 1 ) strict elemental diet , ( 2 ) diet restriction based on allergy testing , and ( 3 ) diet restriction based on eliminating the more common food allergens .
corticosteroids have also been proven to be effective in treating eoe , however clinical and histologic features are known to return with discontinuation of therapy . here
we report the case of a 24-year - old female who was diagnosed with eoe with an atypical presentation .
a 24-year - old woman was referred to our care in march 2011 with a 3-year history of persistent hiccups and mild , intermittent dyspepsia .
her symptoms began with episodic mild chest discomfort lasting one minute followed by bouts of hiccups . over time , the hiccups progressed to up to 10 episodes per day .
she had no prior medical history other than one admission for renal calculi , and her only prescription was birth control pills .
she had no history of allergy and no known family history of illness as she was adopted .
six months before our evaluation she was treated empirically with ranitidine with no relief of her symptoms .
she underwent esophagogastroduodenoscopy ( egd ) , which demonstrated trachealization of the esophagus , and biopsies from the distal esophagus showed significant eosinophilic infiltration .
she was subsequently placed on a 6-week course of high - dose omeprazole ( 40 mg twice daily ) , with minimal relief of her symptoms .
a follow - up egd showed persistent trachealization and esophageal eosinophilia ( peak eosinophil count of 23/hpf ) consistent with a diagnosis of eoe ( fig .
her symptoms improved substantially within 1 week , with hiccups occurring fewer than 2 times per week .
a repeat egd while on treatment demonstrated resolution of trachealization , and biopsies showed histologic remission of eoe ( peak eosinophil count of 5/hpf ) .
fluticasone was subsequently discontinued , but the patient developed recurrent hiccups within a few days .
they are an involuntary spasmodic contraction of the diaphragm and intercostal muscles , resulting in sudden inspiration and closure of the glottis .
multiple causes of hiccups have been described , including gastric or esophageal distention due to overeating or carbonated beverages , phrenic nerve irritation , central nervous system disorders , metabolic , postoperative and psychogenic disorders , medication side effects and reflux esophagitis .
the pathogenesis is unclear , but one proposed mechanism suggests that esophageal receptors send impulses via the vagal nerve to respiratory motor neurons , resulting in hiccups .
eoe is a chronic , immune / antigen - mediated esophageal disease characterized histologically by eosinophil - predominant inflammation and clinically by symptoms related to esophageal dysfunction . due to overlapping clinical features
, the diagnosis of eoe requires distinction from gerd with a trial of a proton pump inhibitor or with ph monitoring .
esophageal eosinophilia led to the initial suspicion of gerd and the initiation of acid - modifying therapy .
our patient achieved minimal relief with an h2 blocker or proton pump inhibitor , suggesting that hiccups were unlikely related solely to gerd .
by contrast , the patient 's clinical , endoscopic and histologic response to topical steroid therapy supports an association between hiccups and eoe and suggests that eoe be considered in the differential diagnosis of patients with refractory hiccups .
the international gastrointestinal eosinophil researchers ( tigers ) concept award ( support to p.a.b . and j.l . ) .
 eosinophilic esophagitis ( eoe ) is a chronic esophageal disease increasingly recognized in adults for its gastrointestinal manifestations . 
 this paper discusses a young woman with eoe who presented with persistent hiccups and intermittent dyspepsia . 
 the patient was initially treated with trials of both h2 blocker and proton pump inhibitor . however , her hiccups resolved only after treatment with topical fluticasone . 
 a repeat upper endoscopy while on steroid treatment demonstrated both histologic remission of eoe and resolution of esophageal trachealization . 
 our patient 's clinical course supports an association between hiccups and eoe , suggesting that eoe be considered in the differential diagnosis of patients with refractory hiccups . 
Introduction
Case Report
Discussion
Grant Support
Disclosure Statement