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CORRESPONDENCE THE BRITTSH 641 MEDICAL JOURNAL64 mother from disproportion. In fact, on the figures his judgement is almost more likely to be confident and accurate if his advice be given by telephone, without seeing the patient. The figures are so reliable and comforting, while the individual case is apt to be so discomforting, especially as labour progresses, or doesn't, as the case may be.

INTRODUCTION: A review of current literature shows eosinophilic esophagitis and sloughing esophagitis as two distinct esophageal conditions that are diagnosed using clinical and pathological findings unique to each condition. Eosinophilic esophagitis is a known inflammatory condition associated with atopy, where high concentrations of eosinophils are found in the esophageal tissues resulting in esophageal dysfunction. Sloughing esophagitis however, is the necrosis and parakaratosis of longitudinal segments of surface esophageal squamous epithelium with intact underlying squamous epithelium underneath. This has been mainly associated with exposure to chemical esophageal irritants such as bisphosphonates and, on rare occasions, inflammatory conditions such as celiac disease. CASE DESCRIPTION/METHODS: We will describe a case of an otherwise healthy adult patient with eosinophilic esophagitis that presented to the emergency department repeatedly for food boluses. She was referred to gastroenterology and diagnosed with eosinophilic esophagitis. Unfortunately she was refractory to standard treatments to manage symptoms such as antiacid agents, inhaled corticosteriods, viscous budesonide, prednisone, and leukotriene receptor antagonists. She underwent a 6 food elimination diet to help identify a food trigger. Although improvement of her symptoms were seen with 6 food elimination, the reintroduction of wheat caused a return of her eosinophilic esophagitis symptoms, as well as findings on endoscopy consistent with sloughing esophagitis. DISCUSSION: An increasing incidence of both conditions presenting in the same patient may be suggestive of a similar underlying mechanism, and given the clinical context of this case, both conditions may be reflective of an immune-mediated response to a specific antigen trigger.