Abstract
Background and Objectives: The initial diagnostic test required to evaluate esophageal dysphagia is upper endoscopy (EGD) to assess the structure of the esophagus and the esophageo-gastric junction (EGJ). Taking biopsies during EGD has become a common practice in patients with dysphagia to rule out eosinophilic esophagitis (EoE). The aims of this study were to evaluate the endoscopic findings of patients who underwent EGD for esophageal dysphagia, to assess the rate of biopsy taking from the esophagus to diagnose/exclude EoE, and to report histology outcomes of these biopsies. Materials and Methods: This was a retrospective multicenter study that included individuals ≥18 years who underwent EGD due to esophageal dysphagia between the years 2015 and2020, (with no other alarm signs, such as weight loss, new iron deficiency anemia, and lymphadenopathy). We obtained data from patients’ electronic files. The endoscopy and histology findings were obtained from endoscopy reports saved in our electronic files. Results: A total of 209 patients were included in the study. The average age was 57.1 ± 17.1 years. The most common endoscopic findings were normal endoscopy in 76 patients (36.4%) and erosive esophagitis in 75 patients (35.9%). Barrett’s esophagus and esophageal malignancy were encountered in 11 patients (5.3%) and 2 patients (0.95%), respectively. Esophageal biopsies were taken in 50.2% of patients, and one patient had histological evidence of EoE (0.5%). On univariate analysis, there was a trend for association between proton pump inhibitors (PPIs) use and a normal EGD, but it was not statistically significant (OR 0.28, 95% CI 0.07–1.11, p = 0.07). Conclusions: Endoscopic findings were prevalent in dysphagia patients even when no other alarm symptoms exist. Neoplastic lesions and EOE were rare in our study.
Highlights
Dysphagia is a very common symptom that may affect up to 20% of patients in the primary care setting and represents a major cause for referral to gastroenterologists [1]
1.9% of patients had a history of atopy (Table 1)
Comparing parameters that were associated with Barrett’s esophagus and neoplastic pathological findings on upper endoscopy (EGD), we found that only chronic proton pump inhibitors (PPI) use for more than 3 months was significantly associated with a lower rate of neoplastic findings (p = 0.006)
Summary
Dysphagia is a very common symptom that may affect up to 20% of patients in the primary care setting and represents a major cause for referral to gastroenterologists [1]. It is defined as the subjective sensation of difficulty swallowing during the passage of liquid or solid bolus, from the mouth to the stomach, or the awareness of an obstruction during the process of swallowing [2]. The aims of this study were to evaluate the endoscopic findings of patients who underwent EGD for esophageal dysphagia, to assess the rate of biopsy taking from the esophagus to diagnose/exclude EoE, and to report histology outcomes of these biopsies. There was a trend for association between proton pump inhibitors (PPIs) use and a normal EGD, but it was not statistically significant
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