Prevalence of Eosinophilic Esophagitis and Lymphocytic Esophagitis in Adults with Esophageal Food Bolus Impaction

Abstract

Background. The relation of esophageal food bolus impaction (FBI) to eosinophilic esophagitis (EoE) and lymphocytic esophagitis (LyE) is unclear. The aim of this study was to determine the prevalence of EoE and LyE among adults with FBI. Methods. In this retrospective study we analyzed data from all patients referred for gastroscopy during the past 5 years, because of a present or recent episode of FBI. Results. We found 238 patients with FBI (median age 51 (17–96), 71% males). Endoscopic therapy was required in 143 patients. Esophageal biopsies were obtained in 185 (78%) patients. All biopsies were assessed for numbers of eosinophils and lymphocytes. EoE was found in 18% of patients who underwent biopsy. We found 41 patients (22%) who fulfilled the criteria for both EoE and LyE (EoE/LyE). LyE was found in the 9% of patients with FBI. EoE together with EoE/LyE was the leading cause of FBI in patients ≤50 years (64%). GERD was the leading cause of FBI among patients older than 50 years (42%). Conclusions. Our study showed that EoE was the leading cause of FBI in particular among young adults. Our study highlights the need for esophageal biopsies in any patient with FBI.

The evolution of treatment and complications of esophageal food impaction

“…13 This significant rise in the incidence of food impaction comes with what has been noted in prior studies of increasing incidence of EoE. 2,3,5,6 The study also gives us several insights into the evolving management of esophageal food impaction. First, glucagon therapy is effective in about one-third of patients.…”

“…Esophageal food impaction is a relatively common acute and urgent gastroenterological issue with an annual incidence of about 13 episodes per 100,000 individuals. 1,2 More recent studies suggest that it is increasing in incidence over time. 3 An underlying esophageal cause leading to food impaction is commonly found, with structural abnormalities (historically, Schatzki ring, peptic stricture) most likely, and dysmotility disorders and malignancy being less common causes.…”

“…Moreover, food impaction related to EoE is likely associated with a higher rate of complications. 2,3,5,6 There are multiple treatment methods for esophageal food impaction, including ingestion of carbonated beverages, medications that affect esophageal motility (glucagon and nitrates most commonly), and endoscopic or surgical removal of the food bolus. [7][8][9][10][11][12] Spontaneous resolution has been reported in up to 25% of food impaction patients.…”

Recognising eosinophilic oesophagitis as a cause of food bolus obstruction

“…This is within the range (18.0%–54.8%) reported by other studies investigating FBO (see table 2). 2 3 14–18 The variation in prevalence rates may be due to the different diagnostic criteria applied. All investigated the management of FBO, but some only included patients listed for endoscopy, indicating selection bias.…”

Epidemiology, etiology and pathogenesis of eosinophilic esophagitis. The latest data

“…Среди пациентов с жалобами на дисфагию вероятность обнаружения ЭоЭ при эндоскопическом обследовании значительно выше -12-23%. У больных с острыми эпизодами вклинения пищи в пищевод ЭоЭ диагностируется не менее чем в 50% случаев [58][59][60][61][62][63][64][65][66][67][68][69][70].…”