A 24-year-old man with asthma and bouts of epigastric pain, nausea, and vomiting

Presentation of Case A 24-year-old man was admitted to the hospital because of nausea and epigastric pain that were unrelieved after a posterior gastropexy for a hiatal hernia. There was a history of adrenocorticosteroid-dependent asthma since childhood, which was controlled with difficulty; anaphylaxis occurred on one occasion after the ingestion of nuts. The total eosinophil count in recent years ranged between 17 and 528 per cubic millimeter. The α1-antitrypsin was normal. Except for intermittent exacerbations of asthma the patient was well until six years before admission, when he began to experience substernal pain with nausea and vomiting; the . . .