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.
Highlights
Esophageal food bolus impaction (FBI) is relatively common in clinical practice with an estimated annual incidence of 13 episodes per 100,000 [1]
Disorders contributing to the episode of FBI included gastroesophageal reflux disease (GERD) (27%), eosinophilic esophagitis (EoE) and lymphocytic esophagitis (LyE) (EoE/LyE) (17%), EoE (14%), pump inhibitors (PPI)-REE (8%), LyE (7%), Schatzki ring (7%), (%) EoE + EoE/LyE
The distribution of aetiologies confirmed by histopathology showed a prevalence of EoE of 18%, which together with compound EoE/LyE reached 40% but together with PPI-responsive esophageal eosinophilia (PPI-REE) even 50% of causes of FBI (Figure 2)
Summary
Esophageal food bolus impaction (FBI) is relatively common in clinical practice with an estimated annual incidence of 13 episodes per 100,000 [1]. Endoscopic abnormalities in patients with EoE include esophageal rings, strictures, narrow-caliber esophagus, linear furrows, white plaques or exudates, and edema [10]. There are no pathognomonic signs for EoE since these endoscopic findings have been described in other esophageal disorders. 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. EoE together with EoE/LyE was the leading cause of FBI in patients ≤50 years (64%). 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
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