Esophageal Food Impaction Research Articles

Esophageal food impaction in children.

To determine the clinical presentation, radiographic, endoscopic and manometric findings, and clinical outcome of esophageal food impaction (EFI) in pediatric patients. We retrospectively reviewed the clinical course of 12 pediatric patients with EFI over a 10-year period. All 12 patients described initially presented to our emergency department for care. Four patients (25%) required previous endoscopic intervention for disimpaction of EFI. Eleven required endoscopic removal of their EFI, and 1 patient's food impaction resolved spontaneously. The mean duration of food impaction was 20 hours prior to endoscopic intervention. Endoscopy demonstrated an esophageal stricture in 1 patient with a history of trisomy 21 and tracheoesophageal fistula repair. While there was no visual evidence of esophagitis in any patient, 5 of 7 had histologic evidence of esophagitis. Upper gastrointestinal series demonstrated the esophagus to be anatomically normal in 10 of 12 patients (83%); 1 patient had an esophageal stricture and another an esophageal web. Four of 8 patients studied had nonspecific esophageal motility abnormalities. EFI in children is not generally associated with underlying esophageal anatomic abnormalities. Esophagitis and nonspecific esophageal motility disorder abnormalities may be etiologic factors. Endoscopic removal of the EFI was safe and effective and is recommended as there is little likelihood of spontaneous resolution of EFI in children.

The use of glucagon in acute esophageal food impaction (EFI): how often does it work?

The use of glucagon in acute esophageal food impaction (EFI): how often does it work?

Retrospective analysis of the treatment of acute esophageal food impaction in a community gastroenterology practice

Retrospective analysis of the treatment of acute esophageal food impaction in a community gastroenterology practice

Modified suction cap technique for endoscopic management of esophageal food impaction.

Modified suction cap technique for endoscopic management of esophageal food impaction.

Esophageal food impaction with alligator meat: a tail of two gators

Esophageal food impaction with alligator meat: a tail of two gators

Long term follow-up of esophageal food impactions: the truth is not that hard to swallow

Long term follow-up of esophageal food impactions: the truth is not that hard to swallow

Retrospective assessment of glucagon in esophageal food impactions

Retrospective assessment of glucagon in esophageal food impactions

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Esophageal food impaction: Epidemiology and therapy. A retrospective, observational study

Background: Esophageal food impaction is common, but incidence data are lacking and management is controversial. This is a survey of its epidemiology, endoscopic findings, and treatment. Methods: A retrospective study was conducted of 194 adults with 223 episodes of esophageal food impaction in a health maintenance organization. Of these, 192 (99%) patients were followed a median of 31 months (range 1-72) post-disimpaction. Results: The estimated annual incidence rate of episodes was 13.0 per 100,000, and the male:female ratio was 1.7:1. The rate increased with age, especially after the seventh decade. The bolus was meat in 189 (85%) episodes. Flexible esophagoscopy was performed initially in 222 (99.6%) episodes and permitted disimpaction in 218 (98%). The push technique was used alone or in combination with extraction in 186 (84%). Immediate dilation was performed in 172 (79%). There were no major complications. A final diagnosis was made in 171 (88%), including 151 (78%) with a Schatzki's ring or peptic stricture, and the diagnosis had changed during follow-up in 14 (7%). A diagnosis of Schatzki's ring was associated with gender (p = 0.03) and decreased with increasing age (p = 0.003), especially among women. Conclusions: Esophageal food impaction is common and can nearly always be treated safely with flexible esophagoscopy, usually with the push technique. (Gastrointest Endosc 2001;53:193-8.)

Outcomes of acute esophageal food impaction: Success of the push technique

Background: Acute esophageal food impaction (AEFI) is the most common form of esophageal impaction in adults. The current recommendation for management is extraction by using an overtube to protect the airway, which facilitates multiple passages of the endoscope and protects the esophageal mucosa. Typically, AEFI in our patients is treated with the push technique, a method found to be highly successful and without complications. Methods: All patients with a diagnosis of AEFI from 1993 to 1998 were identified by computer search of ICD-9 diagnosis code 935.1 (foreign body of the esophagus). Patients were excluded if they were less than 18 years of age, had an acute esophageal foreign body other than food, or if the medical record was incomplete. Results: The analysis included 189 patients: 114 men and 75 women. Of these, 77 (41%) had a Schatzki's ring, 61 (32%) had an esophageal stricture, and 4 (2%) had esophageal cancer. In 47 patients (25%) no obvious structural cause for AEFI was noted at endoscopy. In addition, 67 patients had breaks in the esophageal mucosa. The push technique resolved the food impaction in 184 of 189 (97%) of the patients. In no subgroup was there an instance of perforation, aspiration, or bleeding. Forty-five patients underwent dilation at the time of food disimpaction without complication. Conclusions: The push technique is both safe and effective in the treatment of AEFI. Dilation at the initial presentation of a patient with AEFI likewise appears to be safe. The push technique is recommended as the initial therapy of choice for AEFI. Dilation at the time of esophageal food disimpaction can be considered if there are no obvious contraindications. (Gastrointest Endosc 2001;53:178-81.)

Esophageal food impaction: epidemiology and therapy. A retrospective, observational study.

Background: Esophageal food impaction is common, but incidence data are lacking and management is controversial. This is a survey of its epidemiology, endoscopic findings, and treatment. Methods: A retrospective study was conducted of 194 adults with 223 episodes of esophageal food impaction in a health maintenance organization. Of these, 192 (99%) patients were followed a median of 31 months (range 1-72) post-disimpaction. Results: The estimated annual incidence rate of episodes was 13.0 per 100,000, and the male:female ratio was 1.7:1. The rate increased with age, especially after the seventh decade. The bolus was meat in 189 (85%) episodes. Flexible esophagoscopy was performed initially in 222 (99.6%) episodes and permitted disimpaction in 218 (98%). The push technique was used alone or in combination with extraction in 186 (84%). Immediate dilation was performed in 172 (79%). There were no major complications. A final diagnosis was made in 171 (88%), including 151 (78%) with a Schatzki’s ring or peptic stricture, and the diagnosis had changed during follow-up in 14 (7%). A diagnosis of Schatzki’s ring was associated with gender (p = 0.03) and decreased with increasing age (p = 0.003), especially among women. Conclusions: Esophageal food impaction is common and can nearly always be treated safely with flexible esophagoscopy, usually with the push technique. (Gastrointest Endosc 2001;53:193-8.)

Esophageal food impaction: epidemiology and therapy. A retrospective, observational study.

Esophageal food impaction: epidemiology and therapy. A retrospective, observational study.

The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children

OBJECTIVES: Eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy. METHODS: We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as ≥5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions. RESULTS: Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. Association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy. CONCLUSION: Awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults.

7060 Causitive lesions and long term outcome in patients with esophageal food impaction. an urban hospital experience.

Food impaction in the esophagus is a common problem faced by gastrointestinal endoscopists. While much has been written regarding management of these patients there has been little study of the underlying lesion causing the impaction and the long-term outcome in these patients. In attempt to study these issues we reviewed our recent experience with patients presenting with esophageal foreign body impaction. Methods: The computerized records of upper endoscopies performed during the last 2 years at University Medical center were searched for esophageal food impaction or foreign body in either the indication or findings field. Once records were found charts were reviewed to determine age, gender, findings at endoscopy and follow-up care. An attempt was made to reach the patients via telephone to assess any recurrent symptoms and further endoscopy. Results: There were 1435 endoscopic records searched. 17 individuals were identified as having esophageal foreign bodies. Age range 22-85 Male:Female ratio 8:9. The findings were as follows: Schatzki Ring 2 pts Normal 4 pts Esophagitis 11 pts. 8/11 esophagitis patients were re-endoscoped within one week and 6 demonstrated complete resolution of esophagitis. 13 patients were available for f/u

Nonspecific esophageal motility disorders in children without gastroesophageal reflux.

Nonspecific esophageal motility disorders (NEMDs) have been identified in up to 50% of adults with noncardiac chest pain or dysphagia. This study sought to determine the incidence of NEMDs in children with upper gastrointestinal tract symptoms and to evaluate the clinical course of pediatric patients with these manometric abnormalities. The study involved 154 children aged 4 to 18 years (mean age, 11.6+/-2.6 years [SE]) who had upper gastrointestinal, swallowing-related symptoms. The children were evaluated by 24-hour intraesophageal pH monitoring, esophageal manometry, and esophagogastroduodenoscopy. Gastroesophageal reflux (GER) was diagnosed by pH study in 109 (71%) of 154 patients, and examination of biopsy specimens demonstrated esophagitis in 70 children with GER. Results of esophageal manometry were abnormal in 30 (67%) of 45 children without GER. A variety of motility disorders were diagnosed in 17 of the patients without GER, whereas NEMDs were diagnosed in the remaining 13 children (mean age, 10.6+/-2.7 years; 10 boys, 3 girls). Patients with GER showed normal esophageal wave propagation; however, mean lower esophageal sphincter pressure was significantly lower in patients with GER than in children with NEMDs. The children with NEMDs exhibited a diverse array of symptoms, including esophageal food impaction in 4 of the 13 patients. During a 36.2+/-4.3-month follow-up period, no correlation was found between therapeutic intervention and clinical course in the 13 patients with NEMDs. Symptomatic improvement occurred in 6 of 13 patients, including 3 children for whom no pharmacologic therapy was prescribed. These data indicate that NEMDs represent a common group of esophageal manometric abnormalities in children with upper gastrointestinal tract symptoms and without GER. Food impaction appears to be a relatively frequent complication, and NEMDs should be considered in children who have this finding.

Nonspecific Esophaheal Motility Disorders in Children 589

Nonspecific esophageal motility disorders (NEMD) comprise up to 50% of manometric diagnoses in adults with non-cardiac chest pain or dysphagia. This study sought to determine the incidence of NEMD in children with upper gastrointestinal tract symptoms, and to evaluate the clinical course of pediatric patients with these abnormalities. Study design: We studied 154 children, 4 to 18 years of age (mean ± sem: 11.6 ± 2.6 years), utilizing 24 hour intraesophageal pH monitoring, esophageal manometry and esophagogastroduodenoscopy. Results: Gastroesophageal reflux (GER) was demonstrated by pH studies in 109 of 154 patients (71%). In subjects with GER, manometric studies demonstrated reduced lower esophageal sphincter pressures and normal esophageal wave propagation; and, in biopsies showed esophagitis in 70 patients. Biopsy-confirmed Helicobacter pylori gastritis was found in 11 of 154 patients (7%). Esophageal manometries were abnormal in 30 of 45 subjects without GER (67%), and these included 13 children with NEMD (mean age: 10.6 ± 2.7 years; M:F = 10:3). Children with NEMD manifested a diverse group of symptoms, including 4 of 13 patients who presented with esophageal food impaction. Over a 36.2 ± 4.3 month follow-up period, no correlation was found between therapeutic intervention and the clinical course in the 13 patients with NEMD. Symptomatic improvement occurred in 6 of 13 patients, including in 3 children for whom no pharmacologic therapy was offered. Conclusions: These data indicate that NEMD represents the most common group of esophageal manometric abnormalities in children with upper gastrointestinal tract symptoms and without GER. Food impaction appears to be a relatively frequent complication, and NEMD should be considered in children presenting with this finding.

Acute esophageal food impaction treated by water-soluble contrast esophagography with maneuvers

This report describes a case of acute esophageal food impaction in the lower esophagus treated by proper physical motions during esophagography using water-soluble contrast medium (WSCM). WSCM was used to avoid the complication from unexpected perforation during the examination. Relief of esophageal obstruction may be accomplished by asking the patient to jump up and down on the ground. Esophagography using WSCM combined with appropriate physical motions may be helpful in treating patients suffering from acute esophageal food impaction.

Esophageal food impaction: Risk factors and natural history

Esophageal food impaction: Risk factors and natural history

Extraction of an esophageal food impaction with a Roth retrieval net

Upper gastrointestinal foreign bodies are a commonly encountered problem, with the majority found in the esophagus. The most common foreign body causing esophageal obstruction is a food impaction.1 The purpose of this report is to describe a new technique for the removal of a distal esophageal food impaction utilizing the Roth retrieval net.