Exercise-induced chest pain: an atypical manifestation of eosinophilic esophagitis

Background: Eosinophilic esophagitis is a chronic-inflammatory immune-mediated disease of the esophagus. The most common symptoms of eosinophilic esophagitis are dysphagia for solids and bolus obstruction. Approximately half of the patients complain about spontaneously occurring chest pain. However, some patients with eosinophilic esophagitis suffer from, in addition to the described symptoms, exercise-induced chest pain.

Methods and results: Here we report on several patients presenting with exercise-induced chest pain, with 2 patients presenting exclusively only with this symptom. After a comprehensive evaluation including exclusion of gastroesophageal reflux disease and heart disease, a diagnosis of eosinophilic esophagitis based on endoscopical and histological criteria was unequivocally established. The condition improved rapidly after initiation of a treatment with topical corticosteroids.

Conclusion: Eosinophilic esophagitis should be considered in the differential diagnosis in patients presenting with exercise-induced chest pain, particularly in younger male individuals.