Bolus Impaction Research Articles

Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is arecently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as achronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be afirst sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers aunique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6to 8weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

Food Bolus Impaction in the Era of Increased EoE Recognition: Push and Pull, Biopsy and Dilate Before It Is Too Late

Food Bolus Impaction in the Era of Increased EoE Recognition: Push and Pull, Biopsy and Dilate Before It Is Too Late

Impacto Alimentar Esofágico, um Dilema Diagnóstico

O impacto alimentar esofágico é uma situação que na maioria dos casos é secundária a patologia esofágica congénita ou adquirida, podendo constituir a primeira manifestação da doença. Descreve-se um rapaz, 11 anos, saudável, com sialorreia e dor retrosternal que surgiram subitamente durante o jantar. Foi submetido a endoscopia digestiva alta, que revelou um fragmento de carne impactado no terço distal do esófago (que foi extraído) e estrias longitudinais na mucosa. A análise histológica das biópsias esofágicas foi compatível com eosinofilia esofágica. Iniciou terapêutica com inibidor da bomba de protões com melhoria clínica e histológica. O diagnóstico diferencial das principais causas de impacto alimentar associadas a eosinofilia esofágica, nomeadamente esofagite eosinofílica, doença do refluxo gastroesofágico e eosinofilia esofágica respondedora a inibidor da bomba de protões, constitui um desafio clínico.
 Recebido: 15/10/2016 - Aceite: 11/12/2017

Acute Dysphagia in a 25-Year-Old Male

Author(s): Ullo, Michael; Dym, Robert; Ripper, Jill | Abstract: ABSTRACT: History of present illness: A 25-year-old male with a history of asthma presented to the emergency department (ED) with the sensation of food impaction in the mid-thoracic region and inability to swallow that began twenty minutes prior to arrival after eating chicken. Careful history revealed that the patient had several ED visits for similar episodes during his early childhood. Physical examination was benign with stable vitals. He had a clear oropharynx and normal breath sounds bilaterally. On cardiac auscultation, there was a regular rate and rhythm without appreciable murmur. Significant findings: After an unremarkable chest radiograph was obtained, a computed tomography (CT) scan of the chest was obtained due to possible co-ingestion of bones to rule out perforation. The CT scan demonstrated focal distention of the mid-esophagus due to an impacted food bolus (white arrow). An aberrant right subclavian artery (yellow arrow) was located just distal to the impaction site with partial compression of the esophagus (red arrow). Discussion: Arteria lusoria is an aberrant right subclavian artery. It is the most common embryologic abnormality of the aortic arch, occurring in 0.5% to 1.8% of the population.1 In this condition, the right subclavian artery arises directly off of the aorta, distal to the left subclavian artery, as opposed to the normal branching off the right brachiocephalic artery. While the majority of cases are asymptomatic, occasionally the artery will compress adjacent structures including the trachea and esophagus.2 This phenomenon was first described in 1794 by a London physician who remarked on a fatal case of obstructed deglutition.”3 When the aberrant right subclavian artery causes compression and trachea-esophageal symptoms such as dysphagia, it is termed dysphagia lusoria. The patient was diagnosed with dysphagia lusoria and given an intravenous bolus of glucagon with resolution of symptoms in one hour. He was able to tolerate liquids and solids without difficulty upon discharge. Management of dysphagia varies based on presentation and ability to tolerate oral intake. CT imaging may be useful in cases of recurrent food bolus impactions or high clinical suspicion for aerodigestive injury. Patients unable to swallow may require emergent subspecialist evaluation with additional imaging and endoscopic evaluation. Structural abnormalities such as dysphagia lusoria may ultimately require surgical intervention for definitive resolution of symptoms. Topics: Arteria lusoria, dysphagia, aberrant right subclavian artery.

Outcomes of fundoplication in oesophageal atresia associated gastrooesophageal reflux disease

Aim of the studyConservative management of gastrooesophageal reflux (GORD) in oesophageal atresia (OA) is sometimes inefficient, and fundoplication is required. We assessed the outcomes of fundoplication among OA patients from 1980 to 2016. MethodsAfter ethical consent, hospital records of 290 patients, including 22 referred patients, were reviewed. Included were 262 patients with end–to–end repair. Excluded were patients who underwent oesophageal reconstruction (n=23) or no repair (n=5). Primary outcome measures included survival, retaining the native oesophagus, resolution of GGORD symptoms, failure of fundoplication, and long-term endoscopic results. Main resultsGross types of OA in 262 patients were A (n=12), B (n=2), C (n=217), D (n=10), E (n=19), and F (n=2). Eighty-six (33%) patients, type A (n=12, 100%), B (n=2, 100%), C (n=69, 31%), D (n=3, 30%), and F (n=1, 50%), underwent fundoplication at the median age of 5.4 (IQR 3.1–16) months. Main indications included recalcitrant anastomotic stenosis (RAS) in 41 (48%), respiratory symptoms in 16 (19%), and acute life threatening events (ALTE) in 15 (17%) of patients. Associated tracheomalacia in 25 (29%) patients were treated with aortopexy. Median follow–up was 7.5 (IQR 1.8–15) years. RAS resolved in 30 (73%) patients, whereas 11 (27%) with unresolved RAS underwent oesophageal resection (n=8) or replacement (n=3). Six (7%) patients died of heart failure (n=4), bolus impaction (n=1), and ALTE (n=1). Fundoplication failed in 27 (31%) patients, and 13 (15%) underwent redo fundoplication. Fundoplication failure was predicted by long-gap OA RR=3.8 (95%CI=1.1–13), P=0.04. In total GORD associated symptoms persisted in 7 (8%) patients, including one with permanent feeding jejunostomy. Latest endoscopy showed moderate or severe oesophagitis in 7% of fundoplicated and in 3% nonfundoplicated patients and intestinal metaplasia in 3% and 1% (p=0.20–0.29). ConclusionFundoplication provided a safe and relatively effective control of OA associated symptomatic GORD and oesophagitis. The failure rate of fundoplication was high in those with long-gap OA. Type of studyTreatment study. Level of evidenceIV

The role of maintenance therapy in eosinophilic esophagitis: who, why, and how?

In patients with eosinophilic esophagitis (EoE) who do not respond to proton pump inhibitors, initial anti-inflammatory/anti-eosinophilic treatment is with either topical corticosteroids or dietary elimination. A large body of literature supports the efficacy of these approaches, with histologic response rates in the 50-90% range for steroids and 70% range for the six-food elimination diet. However, these studies are almost all short-term and data evaluating long-term safety and efficacy of either treatment are limited. Nevertheless, because EoE is chronic, symptomatic, endoscopic, and histologic disease activity recurs when successful treatments are stopped. An emerging body of data also suggest that left untreated, persistent eosinophilic esophageal inflammation may progress to fibrostenosis over time. Therefore, maintenance therapy in EoE is intuitively attractive. This paper reviews the rationale for maintenance treatment in EoE, the available long-term pharmacologic and dietary response data for EoE, and discusses who may benefit the most from ongoing treatment. While all patients with EoE can be offered maintenance treatment, this option should be strongly recommended in patients with severe disease phenotypes or complications, including malnutrition or failure to thrive, esophageal fibrostenosis, strictures requiring dilation, recurrent food bolus impaction, history of perforation, and symptoms that recur quickly after treatment discontinuation. In all EoE patients, regular follow-up is also advised.

Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis.

To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. Esophageal perforation is a serious complication of EoE. We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation. Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair. Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.

Eosinophilic Esophagitis Is the Leading Cause of Food Bolus Impaction Requiring Endoscopy in Calgary, Canada

Eosinophilic Esophagitis Is the Leading Cause of Food Bolus Impaction Requiring Endoscopy in Calgary, Canada

A Nationwide Cross Sectional Analysis of the Incidence and Complications of Esophageal Food Bolus Impaction: 2017 Presidential Poster Award

A Nationwide Cross Sectional Analysis of the Incidence and Complications of Esophageal Food Bolus Impaction: 2017 Presidential Poster Award

Endoscopic management of foreign bodies in the upper gastrointestinal tract

Background: Foreign body ingestion and food bolus impaction is a common clinical scenario and can present as an endoscopic emergency. Though majority of them pass spontaneously 10-20% require endoscopic intervention. Flexible endoscopy is recommended as therapeutic measure with minimal complications. The aim of our study is to present 2 years’ experience in dealing with foreign bodies in the upper gastrointestinal tract.Methods: Cases of foreign body (FB) ingestion admitted to department of general surgery from January 2015 to December 2016 were evaluated. The patients were reviewed with details on age, sex, type of FB, its location in gastrointestinal tract, treatment and outcome.Results: A total of 23 cases were studied. Age range was 2-75 years. Males were predominant (60.87%). Coins were found most commonly (52.17%). Esophagus was the commonest site of FB lodgment (65.22%). Upper esophagus being the most common (39.13%). Upper gastrointestinal flexible endoscopy was useful in retrieving FB in all the 23 cases. There were no complications throughout the study period.Conclusions: Flexible endoscopy should be used as definitive treatment and endoscopic treatment is safe and effective.

Endoscopy Upper

Endoscopy Upper

High-definition-iSCAN virtual chromoendoscopy has high sensitivity and specificity for the diagnosis of eosinophilic esophagitis.

Abstract Background and study aims A major challenge in eosinophilic esophagitis (EoE) is disease recognition during endoscopy as there are no pathognomonic findings. We aimed to determine the utility of high-definition (HD) iSCAN virtual chromoendoscopy (VC) in diagnosis of EoE. Patients and methods One hundred eighty-nine consecutive patients presenting with dysphagia or food bolus impaction were assessed using HD-iSCAN VC (Pentax, Japan) with biopsies from distal, mid, upper esophagus and from furrows where visible. Results Of 189 patients, 45 (23.8 %, male = 29, median age 40y) had a histological diagnosis of EoE; 73.3 % of the patients were newly diagnosed. iSCAN endoscopic features of EoE were linear furrows (91 %), edema (77.8 %), rings or tracheal appearance (73.3 %), whitish exudates (26.6 %) and narrowing or stricture (5 %). One patient (2.2 %) had all 5 endoscopic features. Ten patients (22.2 %) had linear furrows, edema,rings or tracheal appearance and whitish exudates on iSCAN, with a positive predictive value (PPV) 100 % (95 % CI 69.1 %-100 %) and negative predictive value (NPV) 80.4 % (95 % CI 73.9 %-86 %). Thirteen patients (29 %) presented with linear furrows, edema and rings or tracheal appearance on iSCAN, with a PPV 100 % (95 % CI 75.3 %-100 %) and NPV 81.8 % (95 % CI 75.3 %-87.2 %). Six patients (13.3 %) had furrows and edema and 6 patients (13.3 %) had furrows and rings or tracheal appearance on iSCAN, with a PPV 100 % (95 % CI 54.1 %-100 %) and NPV 78.69 % (95 % CI 72 %-84.4 %), respectively. The sensitivity and specificity of HD-iSCAN endoscopy were 97.62 % (95 % CI 87.43 %-99.94 %) and 89.58 % (95 % CI 83.40 %-94.05 %). The accuracy of HD-iSCAN endoscopy was 92.47 % (95 % CI 87.67 %-95.56 %). Conclusion HD-iSCAN endoscopy is sensitive and specific with good accuracy for EoE diagnosis. Linear furrows, edema and tracheal appearance were the most common findings and these 3 endoscopic features had a high predictive value for diagnosis of EoE.

Sa1232 Endoscopic Management of Foreign Body Ingestion and Food Bolus Impactation: Experience of a Single Referral Center in Brazil

Foreign body ingestion and food bolus impaction are frequent in emergency departments. About 20% of the cases require endoscopic removal.

Ingestion of foreign bodies among prisoners: a ten years retrospective study at University Hospital of Southern Italy.

We studied 21 episodes of ingestion of foreign bodies (IFO) among 15 prisoners. Rectrospective research in pts admitted to emergency from June 2005 to May 2105. Ingestion, management and pts outcome were analyzed. Prisoners with previous esophagogastroduodenal disease were excluded. All pts were males and ingestions were intentional. Esophagogastroduoduenoscopy (EGDS) was performed in 10pts (8 cases with successful removal, 1 case we did not find anything e 1 of unsuccessful EGDS, that required emergency surgey. 9 pts rejected EGDS: in 2 pts were not necessary.Among the 9 pts that rejected EGDS, 5 discharged voluntary. No mortality neither morbidity. Only 1 pt required surgery.The IFO were 34 (23 sharp, 6 flat,5 indefined). We did not observe any food bolus impaction. Multiple ingestion was found in 11 pts. Recurrent episodes were found in 4 pts. Almost all episodes can be treated conservatively with observation and endoscopy but the management of this pts has a financial impact on healthcare cost and on security costs. Prevention strategies are important to predict patient group at high risk for recurrent IFO.

Mid-Esophageal Food Bolus Impaction Associated with Prominent, Segmental Esophageal Papillomatosis and Squamous Cell Carcinoma

AIM: To describe a case of esophageal food bolus impaction associated with esophageal papillomatosis and a superficial squamous cell carcinoma (SCCa). CASE REPORT: A 62 yo male with a history of hypertension, hyperlipidemia and early stage (F1 disease by biopsy in 2009) type 1a hepatitis C infection, presented to the emergency room with an esophageal food bolus impaction. He sensed mid retrosternal bolus impaction since beginning a meal of pork 3 hours previously. After informed consent was obtained, EGD under moderate sedation revealed a very large pork bolus (2.5X4 cm) which was impacted in the mid esophagus. The food bolus was extracted per os with the use of a friction fit adapter which was attached to a standard video gastroscope. The underlying esophageal mucosa in the mid esophagus was decidedly abnormal (from 28 to 34 cm from the incisors) in a confluent fashion. Over this mid esophageal segment, the lumen was mildly narrowed and there were prominent macroscopic findings consistent with verrucous change (see Figure 1). Biopsies on 2 occasions revealed only esophageal papillomatosis without dysplasia and were negative for HPV. The patient was briefly followed expectantly. Recommendations to masticate food thoroughly, eat slowly and drink plenty of liquids with meals were reinforced. Given the unusual nature of the process, a second opinion was sought at a local tertiary care center. A third EGD was performed and extensive esophageal biopsies were again performed. A small nodular area was noted and biopsies of this region revealed invasive SCCa. Staging PET CT was negative for metastatic spread and it revealed positive uptake in the mid esophagus. Numerous treatment options were considered during multidisciplinary review and in the end, he underwent esophagectomy. The final esophageal resection specimen revealed a 2.0 X 0.5 cm moderately differentiated SCCa (T1a) against a background of papillomatosis.Figure 1CONCLUSION: Histologically, esophageal papillomasare benign tumors composed of fingerlike projections of lamina propria covered by hyperplastic squamous epithelium. Gastroesophageal reflux and HPV have been implicated as possible pathogenic factors. In this case, intense, segmental esophageal papillomatosis caused esophageal lumenal narrowing and led to esophageal food bolus impaction. The finding of a small superficial SCCa was thought to be fortuitous and coincidental.

Esophageal Lumen Restoration Using Ureteral Dilators for Complete Obstructive Aphasia

We present two cases of complete occlusion of the esophageal lumen resulting in complete obstructive aphasia treated with esophageal lumen restoration using Cook ureteral dilators. A 55 year old African American female with history of squamous cell carcinoma status post total laryngectomy with radiation developed pharyngeal stenosis that was treated by multiple dilations; however, her dysphagia progressed to complete inability to swallow. On physical exam, she appeared frail and malnourished with documented 40 pound weight loss. She completely relied on her Percutaneous Endoscopic Gastrotomy (PEG) tube for nutrition. Modified Barium Swallow revealed complete obliteration of esophagus at level of C5. ENT performed the anterograde portion of the exam and GI performed retrograde endoscopy with tri-plane fluoroscopy for penetrating the occluded segment. After reconnection, a biliary guidewire was passed through the stenosis and pulled through under retrograde EGD. First dilations used Cook ureteral dilatores with 6Fr with final dilation of 16Fr. After sequential EGD with dilation, she is now dilated 42Fr and off of tube feeds.Figure 1Figure 2Figure 3A 72 year old male with history of esophageal adenocarcinoma status post chemoradiation treatments presented for evaluation for progressive dysphagia. He declined an offered esophagectomy for personal reasons. He has had numerous food bolus impactions and became solely dependent upon his Percutaneous Endoscopic Gastrotomy (PEG) tube for nutrition. Fluoroscopic esophagram revealed complete occlusion of esophageal lumen above level of aortic arch. Anterograde with simultaneous retrograde esophagogastroduodenoscopy with tri-plane fluoroscopy was performed for penetrating the occluded segment. With biliary guidewire, the stricture was dilated using 6Fr to 18Fr Cook ureteral dilators. His stricture has been dilated to 42Fr and off of tube feeds. Biopsies were taken of the friable mass in distal esophagus concerning for persistent esophageal adenocarcinoma and is currently undergoing chemoradiation. The current technique: simultaneous anterograde and retrograde scope with tri-plane fluoroscopy guided dilation using Cook ureteral dilators can continue to be a safe and successful method for treating obstructive aphasia and remain on a soft or regular diet.

Sa2039 Food Bolus Impaction in Children Is Nearly Always From Eosinophilic Esophagitis

Sa2039 Food Bolus Impaction in Children Is Nearly Always From Eosinophilic Esophagitis

World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease.

PROBIOTICS—THE CONCEPTHistory and DefinitionsA century ago, Elie Metchnikoff (a Russian scientist, Nobel laureate, and professor at the Pasteur Institute in Paris) postulated that lactic acid bacteria (LAB) offered health benefits capable of promoting longevity. He suggested that “intestinal autoint

Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the removal of foreign bodies in the upper gastrointestinal tract in adults. Recommendations Nonendoscopic measures 1 ESGE recommends diagnostic evaluation based on the patient's history and symptoms. ESGE recommends a physical examination focused on the patient's general condition and to assess signs of any complications (strong recommendation, low quality evidence). 2 ESGE does not recommend radiological evaluation for patients with nonbony food bolus impaction without complications. We recommend plain radiography to assess the presence, location, size, configuration, and number of ingested foreign bodies if ingestion of radiopaque objects is suspected or type of object is unknown (strong recommendation, low quality evidence). 3 ESGE recommends computed tomography (CT) scan in all patients with suspected perforation or other complication that may require surgery (strong recommendation, low quality evidence). 4 ESGE does not recommend barium swallow, because of the risk of aspiration and worsening of the endoscopic visualization (strong recommendation, low quality evidence). 5 ESGE recommends clinical observation without the need for endoscopic removal for management of asymptomatic patients with ingestion of blunt and small objects (except batteries and magnets). If feasible, outpatient management is appropriate (strong recommendation, low quality evidence). 6 ESGE recommends close observation in asymptomatic individuals who have concealed packets of drugs by swallowing ("body packing"). We recommend against endoscopic retrieval. We recommend surgical referral in cases of suspected packet rupture, failure of packets to progress, or intestinal obstruction (strong recommendation, low quality evidence). Endoscopic measures 7 ESGE recommends emergent (preferably within 2 hours, but at the latest within 6 hours) therapeutic esophagogastroduodenoscopy for foreign bodies inducing complete esophageal obstruction, and for sharp-pointed objects or batteries in the esophagus. We recommend urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for other esophageal foreign bodies without complete obstruction (strong recommendation, low quality evidence). 8 ESGE suggests treatment of food bolus impaction in the esophagus by gently pushing the bolus into the stomach. If this procedure is not successful, retrieval should be considered (weak recommendation, low quality evidence). The effectiveness of medical treatment of esophageal food bolus impaction is debated. It is therefore recommended, that medical treatment should not delay endoscopy (strong recommendation, low quality evidence). 9 In cases of food bolus impaction, ESGE recommends a diagnostic work-up for potential underlying disease, including histological evaluation, in addition to therapeutic endoscopy (strong recommendation, low quality evidence). 10 ESGE recommends urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for foreign bodies in the stomach such as sharp-pointed objects, magnets, batteries and large/long objects. We suggest nonurgent (within 72 hours) therapeutic esophagogastroduodenoscopy for medium-sized blunt foreign bodies in the stomach (strong recommendation, low quality evidence). 11 ESGE recommends the use of a protective device in order to avoid esophagogastric/pharyngeal damage and aspiration during endoscopic extraction of sharp-pointed foreign bodies. Endotracheal intubation should be considered in the case of high risk of aspiration (strong recommendation, low quality evidence). 12 ESGE suggests the use of suitable extraction devices according to the type and location of the ingested foreign body (weak recommendation, low quality evidence). 13 After successful and uncomplicated endoscopic removal of ingested foreign bodies, ESGE suggests that the patient may be discharged. If foreign bodies are not or cannot be removed, a case-by-case approach depending on the size and type of the foreign body is suggested (weak recommendation, low quality evidence).

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

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.