The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

Abstract Background: Eosinophilic esophagitis (EoE) patients present with dysphagia and often suffer from esophageal food impaction (EFI). EFI can lead to life-threatening perforation, and requires emergent endoscopic intervention. The aim of this study is to evaluate the risk factors for EFI in EoE patients.Methods: This is a retrospective study performed at a tertiary health care system. Medical records and endoscopy images of EoE cases were reviewed. Clinical characteristics and outcomes including EFIs were documented. We used Zip-code median household income as a surrogate for patients’ socioeconomic status.Results: 291 EoE cases were included, mean age was 42 years. Most patients (65%) had classic EoE endoscopic findings including linear furrows and/or concentric rings, however, a significant proportion (47%) had findings suggestive of gastroesophageal reflux disease (GERD), such as the presence of erosive-esophagitis, a hiatal hernia or Schatzki’s ring. 48 patients (16%) developed one or more esophageal food impaction (EFI). The risk of EFI was less likely in the absence of furrows and/or rings; odds ratio (OR) = .28, 95%CI (0.11, 0.72) [P = .008]. Females had less EFI risk; OR = 0.42, 95%CI (0.19, 0.95) [P = .04]. The type of medical insurance and socioeconomic status was not associated with EFI risk.Conclusion: EFI risk is higher in EoE patients with esophageal furrows and/or rings and in men. Aggressive treatment might be required in this population. GERD and EoE can coexist in many patients. Further studies are required to examine the role of the socioeconomic status in EoE complications.

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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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460 High Rates of Loss to Follow-Up After Esophageal Food Impaction in Suspected Eosinophilic Esophagitis: Time to Standardize Care

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000591372.08262.a7 ◽

2019 ◽

Vol 114 (1) ◽

pp. S269-S269

Author(s):

Sarah Donohue ◽

Luke Hillman ◽

Luis Lomeli ◽

Eric Gaumnitz

Keyword(s):

Eosinophilic Esophagitis ◽

Food Impaction ◽

Loss To Follow Up ◽

Esophageal Food Impaction

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Treatment with compounded fluticasone suspension improves the clinical, endoscopic, and histologic features of eosinophilic esophagitis

Diseases of the Esophagus ◽

10.1093/dote/doaa120 ◽

2020 ◽

Author(s):

Corey J Ketchem ◽

Craig C Reed ◽

Zoe Stefanadis ◽

Evan S Dellon

Keyword(s):

Eosinophilic Esophagitis ◽

Medical Records ◽

Clinical Care ◽

The United States ◽

Food Impaction ◽

Histologic Response ◽

Off Label ◽

Endoscopic Findings ◽

Loss Of Response ◽

Routine Clinical Care

Summary No approved medication exists for the treatment of eosinophilic esophagitis (EoE) in the United States, which forces patients to utilize off-label drugs and/or create their own formulations. We assessed the efficacy of a standardized compounded fluticasone suspension. To do this, we performed a retrospective cohort study identifying all EoE patients treated with compounded fluticasone. Compounded fluticasone was prescribed during routine clinical care and dispensed by a specialty compounding pharmacy. Clinical data were extracted from medical records. Outcomes (symptomatic, endoscopic, and histologic) were assessed after the initial and last compounded fluticasone treatment in our system. There were 27 included patients (mean age 34.2; 67% male; 96% white) treated for a mean length of 5.4 ± 4.4 months. The majority (89%) previously utilized dietary elimination or topical corticosteroids, and many (75%) had primary non-response or secondary loss of response to these treatments. After starting compounded fluticasone, symptoms and endoscopic findings improved [dysphagia (89 vs. 56%, P = 0.005), food impaction (59 vs. 4%, P = 0.003), heartburn (26 vs. 4%, P = 0.01), chest pain (26 vs. 8%, P = 0.05), white plaques (63 vs. 32%; P = 0.005), furrows (81 vs. 60%; P = 0.06), and edema (15 vs. 4%; P = 0.16)]. The median of the peak eosinophil counts decreased from 52 to 37 eos/hpf (P = 0.10) and 35% of patients achieved <15 eos/hpf. In conclusion, compounded fluticasone provided a significant improvement in symptoms and endoscopic findings, with more than a third achieving histologic response in a treatment refractory EoE population. Compounded fluticasone should be considered as an EoE management option.

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Eosinophilic esophagitis

Allergy and Asthma Proceedings ◽

10.2500/aap.2019.40.4272 ◽

2019 ◽

Vol 40 (6) ◽

pp. 462-464

Author(s):

Melissa M. Watts ◽

Carol Saltoun ◽

Paul A. Greenberger

Keyword(s):

Eosinophilic Esophagitis ◽

Cell Activation ◽

Erosive Esophagitis ◽

Mast Cell Activation ◽

Dietary Therapy ◽

Pharmacologic Therapy ◽

Food Impaction ◽

High Power Field ◽

Esophageal Eosinophilia ◽

Food Antigens

Eosinophilic esophagitis (EoE) is defined by symptoms related to esophageal dysfunction, persistent esophageal eosinophilia, and exclusion of other etiologies that may be contributing to the condition. EoE is different from erosive esophagitis. In children, symptoms vary by age groups, such as feeding disorders in 2 year olds; vomiting in 8 year olds; and abdominal pain, dysphagia, and/or food impaction in adolescents. Most adults present with dysphagia, food impaction, heartburn, or chest pain. Common endoscopic features in adults with EoE include linear furrows (creases that orient longitudinally), mucosal rings (esophageal “trachealization”), small-caliber esophagus, white plaques or exudates (which are microabscesses of eosinophils), and strictures. Children often present with similar endoscopic features, yet one-third of pediatric patients with EoE have a normal result in an endoscopic examination. Histologic features of EoE include increased intramucosal eosinophils in the esophagus (≥15 eosinophils per high power field), without similar findings in the stomach or duodenum. There also may be eosinophilic microabscesses. In addition to evidence of mast cell activation, mucosa from patients with EoE have increased levels of interleukin 5; supporting eosinophilia; and upregulation of gene expression of eotaxin-3, a chemokine important in eosinophil migration. The majority of patients have evidence of either aeroallergen and/or food sensitization. Dietary therapy is considered first-line therapy for patients with EoE because it is inexpensive and effective, without requiring pharmacologic therapy. Removal of food antigens has been shown to improve symptoms in patients with EoE. Topical corticosteroids improve esophageal eosinophilia and symptoms, and have become the criterion standard of pharmacotherapy.

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Esophageal Food Impaction and Eosinophilic Esophagitis: A Retrospective Study, Systematic Review, and Meta-Analysis

Digestive Diseases and Sciences ◽

10.1007/s10620-015-3723-8 ◽

2015 ◽

Vol 60 (11) ◽

pp. 3181-3193 ◽

Cited By ~ 21

Author(s):

Girish S. Hiremath ◽

Fatimah Hameed ◽

Ann Pacheco ◽

Anthony Olive′ ◽

Carla M. Davis ◽

...

Keyword(s):

Systematic Review ◽

Retrospective Study ◽

Eosinophilic Esophagitis ◽

Meta Analysis ◽

Food Impaction ◽

Esophageal Food Impaction

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DOZ047.96: Esophageal food impaction presenting as life-threatening airway obstruction in children with esophageal atresia

Diseases of the Esophagus ◽

10.1093/dote/doz047.96 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

S Rozycki ◽

T-N Liou ◽

M T Brigger

Keyword(s):

Foreign Body ◽

Airway Obstruction ◽

Esophageal Atresia ◽

Rigid Bronchoscopy ◽

Food Impaction ◽

Esophageal Foreign Body ◽

Acute Airway Obstruction ◽

Respiratory Event ◽

Esophageal Food Impaction ◽

Life Threatening

Abstract Objective An esophageal foreign body rarely presents as an apparent life-threatening event. However, in children with esophageal atresia, strictures and dysmotility can lead to severe food impactions. Given the underlying anatomy of children with esophageal atresia, a unique risk of severe impaction with resultant airway obstruction is possible. This study reports a case of a child in respiratory distress presenting after a choking event where endoscopy revealed near total tracheal compression from esophageal food impaction. Method Case discussion and review of literature are undertaken. Result A 3-year-old boy with trisomy 21 and history of esophageal atresia who had previously undergone successful repair was transported by helicopter after a choking episode. He was witnessed to have cough followed by apnea, cyanosis, and unresponsiveness, for which he underwent the Heimlich maneuver and required chest compressions for a respiratory arrest. He was immediately taken to the operating room for endoscopy with planned foreign body removal. Rigid bronchoscopy noted near complete obstruction of the airway from posterior tracheal wall compression with no airway foreign body. The airway was secured and a combination of rigid and flexible esophagoscopy subsequently extracted a large bolus of chicken. He was observed in the intensive care unit with no further respiratory event after extubation. Conclusion Esophageal dysmotility and strictures are common in children with esophageal atresia who have undergone repair. Mild airway symptoms are common in children with an esophageal foreign body; however, in children with esophageal atresia a high index of suspicion of an esophageal foreign body is requisite in the setting of acute airway obstruction.

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