IntroductionEosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disorder characterized by eosinophil-predominant inflammation [1]. Esophageal eosinophilia may also be seen in gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE) [2,3]. However, the onset of EoE after endoscopic eradication therapy—particularly radiofrequency ablation (RFA)—is rare, with only a single case described in the literature [4]. We report a case of de novo EoE developing after successful RFA for BE.

MethodsA 43-year-old woman with a 10-year history of GERD and BE underwent RFA in 2021 and remained on single-dose proton pump inhibitor (PPI) therapy thereafter. Surveillance esophagogastroduodenoscopy (EGD) in 2022 showed normal-appearing mucosa, while biopsies revealed >15 eosinophils per high-power field (HPF) without dysplasia. After a four-week PPI washout, repeat EGD demonstrated mucosal edema and longitudinal furrows (EREFS score: 2). Biopsies from distal, medium and proximal esophagus showed up to 35 eosinophils/HPF, confirming EoE.

ResultsHigh-dose PPI therapy was initiated, resulting in both symptomatic and histologic improvement. Three-month EGD revealed partial mucosal healing (EREFS score: 1) and reduced eosinophilic count (9 eosinophils/HPF). As of today, the patient maintained sustained clinical, endoscopic, and histologic remission of EoE, with no recurrence of BE or dysplasia.

ConclusionsThis case illustrates the rare occurrence of EoE arising after RFA for BE. Clinicians should consider EoE in patients with previously treated esophageal conditions who develop persistent or unexplained symptoms, even after successful eradication therapy. Early recognition and appropriate management can prevent chronic inflammation and disease-related complications.