S1899 Impaction Distraction: Boerhaave Syndrome Due to Schatzki Ring Mediated Food Impaction

This prospective study was undertaken to evaluate the clinical usefulness of a newly developed one-piece, screw-free, and micro-locking implant system, which was designed to overcome the shortcomings of the existing implant systems. Thirty-eight patients were recruited and randomly and equally assigned to an experimental group (micro-locking one-piece fixture, MLF; n = 19) or a control group (micro-locking abutment, MLA). Cumulative implant survival rates, marginal bone resorptions, probing depths, plaque indices, bleeding indices, and complications were obtained by using clinical and radiographic findings at 6 months and 12 months after prosthesis placement. Complications that occurred multiple times for single implants were counted. During the 12 month observation period, survival rates were 100% in both groups. No significant intergroup differences were observed for marginal bone resorption, probe depth, or bleeding index. However, mean plaque index was significantly lower in the MLF group at 12 months (p < 0.05). During the 12-month observation period, food impaction (26.3%) was the maincomplication in the MLF group and screw loosening (5.3%), prosthesis detachment (5.3%), and food impaction (5.3%) were observed in the MLA group. The results of this study suggest that the one-piece micro-locking implant system offers a predictable treatment method.

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A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.076 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 45-46

Author(s):

K Alazemi ◽

M Alkhattabi ◽

J C Gregor

Keyword(s):

Emergency Room ◽

Healthcare Utilization ◽

Attrition Rate ◽

Quality Improvement Initiative ◽

Food Impaction ◽

Emergency Room Visits ◽

True Rate ◽

Funding Agencies ◽

The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

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Disease-associated DNA methylation signatures in esophageal biopsies of children diagnosed with Eosinophilic Esophagitis

Clinical Epigenetics ◽

10.1186/s13148-021-01072-y ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Caterina Strisciuglio ◽

Felicity Payne ◽

Komal Nayak ◽

Marialuisa Andreozzi ◽

Alessandra Vitale ◽

...

Keyword(s):

Dna Methylation ◽

Eosinophilic Esophagitis ◽

Field Potential ◽

Line Treatment ◽

Food Impaction ◽

First Line ◽

Genome Wide ◽

Epigenetic Signatures ◽

The Impact ◽

First Line Treatment

AbstractEosinophilic esophagitis (EoE) is a leading cause of dysphagia and food impaction in children and adults. The diagnosis relies on histological examination of esophageal mucosal biopsies and requires the presence of > 15 eosinophils per high-powered field. Potential pitfalls include the impact of biopsy sectioning as well as regional variations of eosinophil density. We performed genome-wide DNA methylation analyses on 30 esophageal biopsies obtained from children diagnosed with EoE (n = 7) and matched controls (n = 13) at the time of diagnosis as well as following first-line treatment. Analyses revealed striking disease-associated differences in mucosal DNA methylation profiles in children diagnosed with EoE, highlighting the potential for these epigenetic signatures to be developed into clinically applicable biomarkers.

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Empiric proton pump inhibitor therapy after esophageal food impaction may mask eosinophilic esophagitis diagnosis at follow-up

Diseases of the Esophagus ◽

10.1093/dote/doab030 ◽

2021 ◽

Author(s):

Luke Hillman ◽

Sarah Donohue ◽

Aimee Teo Broman ◽

Patrick Hoversten ◽

Eric Gaumnitz ◽

...

Keyword(s):

Proton Pump Inhibitor ◽

Proton Pump ◽

Eosinophilic Esophagitis ◽

Empiric Therapy ◽

Proton Pump Inhibitor Therapy ◽

Significant Heterogeneity ◽

Food Impaction ◽

Esophageal Food Impaction ◽

The Impact

Summary Esophageal food impaction (EFI) is often the first presentation for patients with eosinophilic esophagitis (EoE); however, there is significant heterogeneity in the management of EFI. We aimed to study the impact of EFI management, particularly post-EFI medication prescriptions on EoE diagnosis, follow-up, and recurrence in patients with endoscopic features of EoE. In our retrospective study, adults presenting between 2007 and 2017 with EFI requiring endoscopic dis-impaction with endoscopic features of EoE (furrows, rings, and/or exudates) were included. We examined the impact of demographics and EFI management on EoE diagnosis, follow-up (esophagogastroduodenoscopy [EGD] or clinic visit within 6 months), and recurrence. We identified 164 cases of EFI due to suspected EoE. Biopsy was performed in 68 patients (41.5%), and 144 patients (87.8%) were placed on proton pump inhibitor (PPI) and/or swallow corticosteroids after EFI, including 88.5% of those not biopsied. PPI use at time of biopsy was negatively associated with EoE diagnosis (odds ratio: 0.39, confidence interval: 0.17–0.85). Sixty-one (37.4%) patients were lost to follow-up at 6 months. Recurrent EFI at 1 year occurred in 3.7% of patients. Medications, most commonly PPI, are frequently prescribed after EFI when the endoscopic features of EoE are present, which may mask the diagnosis of EoE on follow-up EGD. We estimated that for every five patients biopsied on PPI, one case of EoE is masked. As recurrent EFI within 1 year is uncommon, empiric therapy should be avoided until diagnostic biopsies are obtained. Further efforts to reduce loss to follow-up after EFI are also needed.

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