Management Of Esophageal Food Impaction Research Articles

A Case Report of Food Impaction Relieved by Warm Water Drinking Therapy

BackgroundEmergency department (ED) management of esophageal food impaction without high-grade obstruction is highly variable, without definitive and validated interventions being supported in medical literature. Case ReportWe discuss a 34-year-old male patient with diagnosis of eosinophilic esophagitis and history of multiple food impactions presenting to the ED with a food impaction. Based on a known esophageal history with repeated failure of pharmacologic interventions, the patient was submitted to a new conservative treatment of warm water drinking. Why Should an Emergency Physician Be Aware of This?This case report suggests warm water ingestion as a novel, safe, and successful treatment method in the management of esophageal food bolus impaction. As a conservative treatment not deviating greatly from current ED treatment options, it can reduce patient length of stay and decrease exposure to potential morbidity via invasive endoscopic or surgical intervention. It should be further investigated and validated with a large cohort study.

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

INTRODUCTION: Esophageal food impaction (EFI) is often the first presentation for patients with eosinophilic esophagitis (EoE). Management of EFI when EoE is suspected lacks evidence-based guidelines. The goals of this study are to evaluate the biopsy rates, medical management, follow-up and recurrence of EFI in patients with suspected EoE. METHODS: Adult patients presenting with EFI between 2007-2017 were identified by ICD-9 (935.1) and ICD-10 (T18.1) codes for foreign body in the esophagus. Inclusion criteria required endoscopic intervention with documentation of suspected EoE: defined as endoscopic features of rings, furrows, edema or exudate. RESULTS: We identified 471 cases of EFI requiring endoscopic intervention, with 171 suspected to have EoE. The biopsy rate at time of EFI for patients with suspected EoE was 46%. When patients were not biopsied at time of EFI (n = 93), the majority were initiated on empiric therapy without histologic diagnosis: PPI (90%) and topical steroids (1%). Follow-up endoscopy was recommended in 97% of patients not biopsied at time of EFI and 32% (n = 27) were lost to follow-up. Empiric therapy after EFI did not impact the diagnostic yield at time of follow-up endoscopy (median: 36 days) as rates of diagnostic biopsy (≥15 eos/hpf) were similar compared to those biopsied at time of EFI (66% vs 65%, P = 0.612). Time to follow-up endoscopy did not impact diagnostic yield (P = 0.21). While on therapy, 16% of patients (n = 9) had low level esophageal eosinophilia (5-14 per hpf) on follow-up EGD (median: 29 days). Over the 11 year period, recurrent EFI occurred in 16 patients (3.4%) with a median time to recurrence of 1.65 years. CONCLUSION: EFI presents a unique opportunity to diagnose, treat and establish care for patients with EoE. Our study identified low rates of esophageal biopsy and high rates of loss to follow-up. Empiric therapy did not impact diagnostic yield on subsequent endoscopy with early follow-up. Low level eosinophilia while on therapy should be interpreted cautiously as this may represent partially treated disease. Although uncommon, EFI and recurrence are a disease defining event that create significant patient discomfort and require costly intervention. Our study highlights the need for standardize practice at the time of EFI when EoE is suspected including a structured system to streamline outpatient care, avoid loss to follow up and ultimately, prevent long term complications from this chronic disease.

Management of Esophageal Food Impaction Varies Among Gastroenterologists and Affects Identification of Eosinophilic Esophagitis.

Esophageal food impaction (EFI) is a gastrointestinal emergency requiring immediate evaluation in the emergency room (ER) and an esophagogastroduodenoscopy (EGD) for disimpaction. EFI is also a distinct presenting feature of eosinophilic esophagitis (EoE). This study aimed at understanding the management of EFI among gastroenterologists (GIs) and estimated its impact on identification of EoE in USA. GIs associated with three major gastroenterology societies based in USA were invited to participate in a web-based survey. Information on the resources available and utilized, and the clinical decision-making process related to management of EFI cases was collected and analyzed. Of 428 responses, 49% were from pediatric GIs, 86% practiced in the USA, and 78% practiced in an academic setting. Compared to the pediatric GIs, adult GIs were more likely to perform EGD in the emergency room [OR 87.96 (25.43-304.16)] and advance the food bolus into stomach [5.58 (3.08-10.12)]. Only 34% of respondents obtained esophageal biopsies during EGD, and pediatric GIs were more likely to obtain esophageal biopsies [3.49 (1.12-10.84)] compared to adult GIs. In USA, by our conservative estimates, 10,494 patients presenting to ER with EFI and at risk of EoE are likely being missed each year. EFI management varies substantially among GIs associated with three major gastroenterology societies in USA. Based on their practice patterns, the GIs in USA are likely to miss numerous EoE patients presenting to ER with EFI. Our findings highlight the need for developing and disseminating evidence-based EFI management practice guidelines.

Etiology and management of esophageal food impaction: a population based study

Objective. Esophageal food impaction (FI) is a common clinical problem with limited information on incidence. Previous population based studies are lacking. The incidence, main etiological factors, recurrence and outcome of FI was determined in the present study in a population based setting. Material and methods. This was a study of consecutive adult patients who presented with FI from 2008 to 2013 at the National University Hospital of Iceland. The mean crude incidence rate of FI was calculated. Retrospective analysis was undertaken on relevant clinical data such as type of bolus, management, complications, recurrence rate, risk factors for recurrence, and outcome. Results. Overall 308 patients had endoscopically confirmed FI, males 199/308 (65%), median age 62 years. The mean crude incidence was 25 per 100,000 inhabitants per year. The types of FI was meat (68%), fish (12%), vegetable (4%) and other food/objects (16%). Causes for the FI included: esophageal strictures (45%), hiatal hernia (22%), eosinophilic esophagitis (EoE) (16%) and esophageal carcinoma (2%). Recurrence appeared in 21%, in which 24/48 (50%) had EoE vs. 40/260 (15%) in others (p = 0.0001). The removal of the foreign body was successful in 98% of the cases during the first endoscopy. Endoscopic associated complications included four (1.3%) aspirations, one (0.3%) esophageal perforation and one Boerhaave syndrome at presentation (both had EoE). Conclusions. The incidence of FI is the highest reported to date. EoE was strongly associated with recurrence of FI. In a population based setting endoscopy is a safe and effective procedure for removing FI.

Review of Foreign Body Ingestion and Esophageal Food Impaction Management in Adolescents

Foreign body ingestion is a common clinical scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life threatening. Initial and follow-up management strategies depend on multiple patient and ingested object-related factors. Available literature on this topic tends to focus on the small child or adult, leaving the clinician caring for adolescents to extrapolate this information to guide decision making for individual patients. This article reviews foreign body ingestion literature with important implications to the adolescent patient and raises awareness of some highly dangerous objects such as large button batteries, high-powered magnets, long sharps, narcotic packages, and super absorbent objects. An additional focus includes the management of esophageal food impaction. We highlight the unique aspects to the care of the adolescent with intentional ingestion and co-morbid psychiatric illness. The article concludes by discussing the challenges to prevention of ingestion in the at-risk patient.

Retrospective Analysis of Esophageal Food Impaction: Differences in Etiology by Age and Gender

Eosinophilic Esophagitis (EE) is an emerging cause of esophageal food impaction (EFI) not accounted for in previous studies. We sought to determine the causes of EFI in a recent cohort with recognition of EE. A retrospective chart review of all patients with EFI during the past 5 years was performed. Etiology was determined by endoscopy report, pathology results, and follow-up studies. A total of 85 EFIs occurred, in 79 patients (55 men, 30 women, age 18-100). The most common etiologies of EFI were Schatzki's ring (n = 18), peptic stricture (n = 18), EE (n = 9), esophagitis (n = 9), and no underlying diagnosis (n = 20). EE was significantly more frequent in men (P < .025) and those <50 years old (P < .025). There was a significant difference in the age at which men (median age = 44) and women (median age = 71) present with EFI (P < .001). The etiology of EFI differs significantly by age and gender. This information may be useful in evaluation and management of EFI.

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

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