Esophageal Bolus Research Articles

Chicago Classification update (V4.0): Technical review on diagnostic criteria for ineffective esophageal motility and absent contractility.

Esophageal hypomotility disorders manifest with abnormal esophageal body contraction vigor, breaks in peristaltic integrity, or failure of peristalsis in the context of normal lower esophageal sphincter relaxation on esophageal high-resolution manometry (HRM). The Chicago Classification version 4.0 recognizes two hypomotility disorders, ineffective esophageal motility (IEM) and absent contractility, while fragmented peristalsis has been incorporated into the IEM definition. Updated criteria for ineffective swallows consist of weak esophageal body contraction vigor measured using distal contractile integral (DCI, 100-450mmHg·cm·s), transition zone defects >5cm measured using a 20mmHg isobaric contour, or failure of peristalsis (DCI<100mmHg·cm·s). More than 70% ineffective swallows and/or ≥50% failed swallows are required for a conclusive diagnosis of IEM. When the diagnosis is inconclusive (50%-70% ineffective swallows), supplementary evidence from multiple rapid swallows (absence of contraction reserve), barium radiography (abnormal bolus clearance), or HRM with impedance (abnormal bolus clearance) could support a diagnosis of IEM. Absent contractility requires 100% failed peristalsis, consistent with previous versions of the classification. Consideration needs to be given for the possibility of achalasia in absent contractility with dysphagia despite normal IRP, and alternate complementary tests (including timed upright barium esophagram and functional lumen imaging probe) are recommended to confirm or refute the presence of achalasia. Future research to quantify esophageal bolus retention on stationary HRM with impedance and to understand contraction vigor thresholds that predict bolus clearance will provide further refinement to diagnostic criteria for esophageal hypomotility disorders in future iterations of the Chicago Classification.

Pharmacological Treatments of Esophageal Dysphagia

Patients with esophageal dysphagia need a step-by-step approach for diagnosis and treatment. Endoscopic with biopsy and barium esophagogram are the essential tests evaluating anatomical abnormality and esophageal bolus stasis. Further imaging or esophageal function tests such as high-resolution esophageal manometry, functional endoluminal imaging probe, CT or endoscopic ultrasound are required. In the case of dysphagia due to esophageal motility disorder, whether it is the major motility disorder or minor motility disorder should be identified in high resolution manometry. Major motility disorders show esophagogastric junction obstruction or major peristaltic defects. In this case, the severity of the symptoms should be assessed and patients who need endoscopic or surgical treatment targeting lower esophageal sphincter should be screened. Impaired lower esophageal sphincter relaxation (achalasia, esophagogastric junction outflow obstruction, esophageal spasm or abnormal hypercontraction (jackhammer esophagus), hypotensive contraction (ineffective esophageal motility, failed peristalsis), esophageal hypersensitivity (noncardiac chest pain), gastroesophageal reflux disease and esophageal bolus stasis are the possible mechanisms causing dysphagia symptoms. The proper medical treatment depends on underlying mechanisms.

Food bolus and oesophageal foreign body: a summary of the evidence and proposed management process

Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.

Frequency of Patients Passing an Impacted Esophageal Meat Bolus by Conservative Method Alone

Objectives: To determine the frequency of patients passing the impacted esophageal meat bolus by conservative management Methods: After obtaining permission from ethical committee of Hospital,a total of 62 patients meeting the study criteria were recruited in the study which was conducted in Department of Otorhinolaryn-gology, Services Hospital, Lahore. Demographic information (name, age, gender, contact) was also obtained. Patients with clinical suspicion of impacted esophageal food bolus of age 20-50 years of either gender were included. Patients with known esophageal abnormalities like stricture, web or growth on either barium swallow or esophagogastroduodenoscopy, peptic ulcer and GERD were excluded. After taking informed written consent from each patient, single intravenous dose of buscopan 20mg was given to each patient. Each patient was followed by the researcher himself for 24 hours to assess the passage of food bolus. Results: 20-50 years was the age range in our study, with mean age being 34.10± .63 years. Majority of the patients 32 (51.61%) were between 20 to 35 years of age. Out of 62 subjects, 37 (59.68%) were male, 25 (40.32%) were females with male to female ratio 1.5:1. In our study, Frequency of patients passing the impacted esophageal meat bolus by conservative management was found in 51 (82.26%) patients. Conclusion: This study concluded that there is a high frequency of patients passing the impacted esophageal meat bolus by conservative management. Keywords: Esophagus, foreign body, conservative management.

What is the role of high-resolution oesophageal manometry in paediatrics?

Abnormal oesophageal motility may impair oesophageal bolus transport leading to symptoms of chest pain and regurgitation. Oesophageal pathophysiology may include neuromuscular and/or structural defects leading to weak, incoordinate or absent peristalsis and impaired oesophago-gastric junction relaxation. Understanding these mechanisms is important to determine the appropriate course of therapy. Whilst, barium oesophagram is the mainstay for clinical investigation of oesophageal motility, high-resolution manometry is now more widely available. This review describes the potential value of high-resolution manometry in paediatric gastroenterology practise.

S0408 Esophageal Food Bolus Impaction and the Missed Opportunity to Diagnose and Manage EoE

INTRODUCTION: Esophageal food impaction may be the initial presentation for patients with undiagnosed eosinophilic esophagitis (EoE). These acute encounters offer physicians an opportunity to biopsy and potentially diagnosis the condition. Though prior studies are limited, they have shown patients presenting with food impaction are often not biopsied and have high inadequate follow-up. This creates concerns that patients are undertreated and at risk for future complications. We aim to augment and expand on prior studies by examining follow-up, treatment recommendations, and other EGD findings in patients presenting with acute food bolus impaction. METHODS: We conducted an IRB approved retrospective chart review at a tertiary medical center of patients presenting with esophageal food bolus removed by EGD. Exclusion criteria were esophageal blockage not due to a food bolus, patients with prior established diagnosis of EoE, and patients with other etiologies for food impaction including: esophageal cancer, external compression of the esophagus, or underlying esophageal dysmotility. Over a 3-year period, 134 EGD’s were performed for food bolus impaction with 100 patients ultimately meeting inclusion and exclusion criteria. Categorical data was analyzed using the Chi-Square test while quantitative data was analyzed with the t-test. RESULTS: Our patients were 68% male, 93% Caucasian, and an average age of 62 years. 84% had a follow-up scheduled, but only 49% of total patients followed-up. Only 28% of the patients were biopsied at the time of food bolus impaction. Patients who didn't receive a biopsy were less likely to be given treatment recommendations (7.1% vs. 31.9%, P = 0.011) and more likely to have subsequent food bolus impactions (13.9% vs 0%, P < 0.039). Patients who were younger (54 years vs. 65.7 years) and had gross findings suggestive of EoE (46.2% vs. 15.3%) were also more likely to receive a biopsy. CONCLUSION: Our study suggests that patients presenting with a food impaction of unknown etiology should receive an esophageal biopsy during that initial encounter to exclude EoE. Many patients with EoE do not have typical findings of EoE on gross inspection. Without biopsy, numerous patients will go undiagnosed and be lost to follow-up placing them at risk for future complications. Currently, no guidelines establish clear guidance on this matter. In addition, methods to improve follow-up adherence in these patients may be beneficial.Table 1.: Follow-up and Biopsy

S0381 Incidence and Seasonal Variation of Food Bolus Impaction in Patients With Underlying Eosinophilic Esophagitis

INTRODUCTION: Eosinophilic Esophagitis (EoE) is a chronic disorder of the esophagus characterized as a condition with esophageal symptoms such as dysphagia and an identifiable eosinophilic infiltrate on biopsies in the absence of other etiology. Studies into the reason for the recent rise in incidence and prevalence have discussed the environmental factors that may be associated with the disorder with the pathogenesis thought to be a combination of inflammatory and allergy mediated. In this setting, reports have found that cases can be provoked by aeroallergens and the observation of seasonal variation and geographic variation in presentation. The primary aim of this study was to search for a potential seasonal variation in the presentation of esophageal food bolus impaction in patients with EoE. METHODS: A retrospective analysis of endoscopies completed from May 2017 through April 2019 for foreign body removal or with food found in the esophagus was performed. The study identified a total of 177 cases with 19 cases of esophageal food bolus impaction in patients with established or newly identified EoE. Cases were analyzed regarding seasonal variation in incidence of food bolus impaction and demographic data and variables such as eosinophil count on biopsy and level of impaction were also analyzed using Fisher’s exact test. RESULTS: The overall incidence of esophageal food impaction in cases of EoE was higher in the winter with 10/19 (52.6%) of overall cases occurring in winter compared to 3/19 (15.8%) in other seasons although this did not reach statistical significance (P = 0.0561). 63.2% of the patients were male and 89.5% were white. The difference in eosinophil count and level of impaction did not significantly vary by season (P = 0.5885 and 0.4250). There were four observable strictures found in the group. CONCLUSION: In our study there was a higher incidence of food impaction in the winter season but this did not reach statistical significance. No difference was found in the magnitude of the eosinophilic infiltrate in biopsy specimens by season or by level of impaction. Previous studies have had differing findings on the role of aeroallergens in the pathophysiology and presentation of EoE as well as the presence of seasonal variation and the specific season. Due to these varied findings and small numbers in our study, ongoing evaluation is warranted to shed further light on the presence of possible seasonal variation and the impact environment has on EoE.Figure 1.: Esophageal Food Impaction by Season (P = 0.0561).Figure 2.: Eosinophil Count by Season.Figure 3.: Level of Impaction by Season (P = 0.4250).

S1946 Plummer-Vinson Syndrome: A Rare Cause of Dysphagia in an Octogenarian

INTRODUCTION: Plummer-Vinson syndrome (PVS) is a rare disease that presents with iron deficiency anemia, dysphagia, and esophageal webs. It usually occurs in middle aged women of Caucasian ethnicity and increases the risk for esophageal cancer. Prevalence of PVS has decreased due to early detection of iron deficiency and repletion of iron stores. While PVS has also been commonly described in children and adolescents, it is seldom reported in the elderly population. CASE DESCRIPTION/METHODS: An 88-year-old female with a history of mild cognitive impairment, allergic rhinitis, and GERD presented with dysphagia to solid foods along with a decreased appetite and a ten pound weight loss during the past one year. Physical exam showed bilateral mild erythema of the angle of the mouth. Routine lab work revealed a normal WBC count, platelet count, basic metabolic profile but did have iron deficiency anemia (Hb 11.9 g/dL, iron saturation 11% and ferritin of 8 ng/ml). She was prescribed 324 mg daily dose of ferrous gluconate. Three months later, she presented to the ER with food impaction and underwent EGD to remove a food bolus in the cervical esophagus. Localized erythematous mucosa with erosions was noted in the esophagus at the site of food impaction. Normal oropharyngeal function was found during speech pathology evaluation while a video fluoroscopic barium swallow showed localized narrowing in the cervical esophagus along with transient pill retention (Image 1). New labs indicated good response to iron replacement (hemoglobin 14 g/dL, iron saturation 23%, and ferritin of 26 ng/ml). An EGD was repeated three weeks later which demonstrated normal appearance of pharynx and upper esophageal sphincter. Upon careful inspection, an upper esophageal web, 18 cm from the incisors, was noted and dilated using controlled radial expansion (CRE) balloon (Image 2). Biopsy was taken from the upper and lower esophagus which revealed normal mucosa. On follow up, patient reported resolution of difficulty swallowing. DISCUSSION: Dysphagia is reported in up to 10% of the elderly population. It commonly causes malnutrition, and is associated with increased mortality. The usual etiologies include cognitive dysfunction, neurological diseases and/or esophageal disorders. To our knowledge, this is the third case of PVS related dysphagia reported in an octogenarian in the literature. Iron replacement can help resolve dysphagia in PVS but, occasionally, dilation of esophageal webs may be required.Image 1.: Video fluoroscopic barium swallow shows cervical esophagus narrowing (arrow).Image 2.: Esophageal web located 18 cm from the incisors (A). CRE balloon dilation of esophageal web (B) resulting in mucosal tear and disruption on the web (C &D).

S0352 Endoscopic Biopsies During Presentation for Esophageal Food Impaction: An Important Opportunity for Timely Diagnosis of Eosinophilic Esophagitis

INTRODUCTION: Esophageal food impaction (EFI) is a common initial presentation of eosinophilic esophagitis (EoE). Patients presenting with EFI requiring endoscopic intervention present an opportunity to obtain esophageal biopsies to evaluate for EoE and optimize diagnostic yield before initiation of empiric treatment. We aimed to evaluate practices of esophageal biopsy at time of EFI at our institution and identify missed opportunities to diagnose EoE. METHODS: We performed a single center retrospective chart review on a subset of adult patients from 10/2015 -1/2020 who presented to NYU Langone Health with EFI. Patients who underwent upper endoscopy (EGD) and were found to have a retained esophageal food bolus were included. Those with prior diagnosis of EoE were excluded. Proportions were compared using Chi-square or Fisher’s exact test, and rank sum tests were used to compare continuous variables. Logistic regression was used to assess factors associated with subsequent need for diagnostic EGD. RESULTS: 123 patients with EFI were reviewed, 50 (40.7%) were biopsied at the time of EGD (Table 1). Among those biopsied, a new diagnosis of EoE was found in 52%. Of the patients who did not undergo biopsy at index EGD, 23% underwent repeat EGD at our institution and were found to have a new EoE diagnosis. Biopsies performed during EGD for EFI did appear to decrease the need for repeat procedure (OR 0.63, 95% CI 0.25-1.63), although not statistically significant. Patients with furrows were more likely to be biopsied however the report of other classic endoscopic features of EoE (such as exudates, ring, stricture, edema), was not significantly associated with the rate of biopsy (Table 2). Time of procedure and history of prior EFI also did not appear to influence rate of biopsy. CONCLUSION: Biopsy at the time of EFI is important to obtain a timely diagnosis of EoE. At our center, less than half of patients were biopsied at time of initial EGD for EFI, and over half of those biopsied were diagnosed with EoE. The diagnosis of EoE was missed in 23% patients who were not biopsied at time of EFI, and on subsequent EGD with biopsy were found to have EoE. This delay in biopsy likely leads to unnecessary EGDs and more patients who are unaware of their diagnosis. Future educational initiatives aimed at GI providers are needed to improve rates of biopsies during initial EGD for EFI to reduce the need for additional diagnostic procedures.Table 1Table 2

S0402 Esophagogastric Junction Outflow Obstruction Is Associated with Impaired Bolus Clearance Compared to Controls

INTRODUCTION: The manometric diagnosis of esophagogastric junction outflow obstruction (EGJOO) can be ambiguous and not indicate true functional obstruction at the lower esophageal sphincter (LES). The aim of our study was to identify the presence of impaired esophageal bolus clearance in patients with EGJOO diagnosed via high-resolution manometry (HRM), and compare to a group controls (patients with normal HRM studies) who presented with dysphagia and similar symptoms. METHODS: 12 months of High-Resolution Impedance Manometry (HRIM) results at a large academic center (Wake Forest Baptist Medical Center) were reviewed. Studies diagnostic for EGJOO based on the Chicago Classification of Esophageal disorders (CCv3) were identified. In the group of patients with EGJOO, those with impaired bolus clearance were identified. Impaired bolus clearance was defined as patients with bolus clearance <80%. As a control, a group of HRIM labeled as normal studies were also identified. Incidence of impaired bolus clearance in this group was also recorded, and later compared to that of the EGJOO group. RESULTS: After reviewing the HRIM results, 121 patients were found to have HRIM consistent with the diagnosis of EGJOO. Another 121 patients were identified as having normal manometries. Using the criteria for impaired bolus clearance (<80%), each group was divided into normal vs impaired clearance. In the EGJOO group, 64 (52.9%) patients were found to have impaired clearance, vs 57 (47.1%) which had normal bolus clearance. This was compared to the normal HRIM group, where 16 (13.2%) patients were found to have impaired bolus clearance, while 105 (86.8%) patients were found to have normal bolus clearance. Using a chi square calculation, results were found to be significant (P < 0.01). Table 1 summarizes demographics. Table 2 summarizes the bolus clearance data. CONCLUSION: Patients with EGJOO diagnosed with HRIM were found to have significantly impaired bolus clearance compared to normal subjects. Abnormal liquid bolus transit on impedance analysis may be a useful measure to define clinically significant outflow obstruction. Further investigation of these patients’ subsequent studies, such as timed barium esophagrams, is warranted to fully assess esophageal emptying.Table 1.: DemographicsTable 2.: Results

Coexisting Abnormal Esophageal Body Motility Predicts Clinical Symptoms and Bolus Transit in Patients With Esophagogastric Junction Outflow Obstruction (EGJOO).

The goal of this study was to compare the clinical presentations of esophagogastric junction outflow obstruction (EGJOO) with coexisting abnormal esophageal body motility (EBM) to isolated EGJOO. The clinical significance and management of EGJOO remain debated, as patients may have varied to no symptoms. The effect of coexisting abnormal EBM in EGJOO is unclear. We hypothesized that a concomitant EBM disorder is associated with clinical symptoms of EGJOO. This was a retrospective cohort study of consecutive adults diagnosed with EGJOO on high-resolution impedance-manometry (HRIM) at 2 academic centers in March 2018 to September 2018. Patients with prior treatment for achalasia, foregut surgery, or evidence of obstruction were excluded. Subjects were divided into EGJOO with abnormal EBM per Chicago classification v3.0 and isolated EGJOO. Statistical analyses were performed using Fisher-exact or Student t test (univariate) and logistic or linear regression (multivariate). Eighty-two patients (72% women, age 61.1±10.7 y) were included. Thirty-one (37.8%) had abnormal EBM, including 16 (19.5%) ineffective esophageal motility and 15 (18.2%) hypercontractile esophagus. Esophageal symptoms (heartburn, regurgitation, chest pain, dysphagia) were more prevalent among those with abnormal EBM (90.3% vs. 64.7%, P=0.01). On logistic regression adjusting for age, gender, body mass index, and opioid use, abnormal EBM remained predictive of esophageal symptoms (adjusted odds ratio [aOR] 7.51, P=0.007). On separate models constructed, HE was associated with chest pain (aOR 7.45, P=0.01) and regurgitation (aOR 4.06, P=0.046), while ineffective esophageal motility was predictive of heartburn (aOR 5.84, P=0.009) and decreased complete bolus transit (β-coefficient -0.177, P=0.04). Coexisting abnormal EBM is associated with esophageal symptoms and bolus transit in patients with EGJOO.

Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report.

Plain film, esophageal food bolus impaction, esophagitis, esophageal dysmotility, obstruction.

Eosinophilic esophagitis (EoE); a disease that must not be neglected - implications of esophageal rupture and its management

BackgroundThe prevalence of Eosinophilic esophagitis (EoE) is increasing, a severe complication of EoE is spontaneous perforation of the oesophagus. It is of great importance to be aware of this risk and handle this severe complication carefully.Case presentationA middle-age man with EoE since 2004, had a total esophageal bolus obstruction while eating lunch at the local hospital. Drinking water, in an attempt to release it, led to a total intramural ruptur of the esophageal wall. A CT scan detected the injury and a covered esophageal stent was inserted within 2 h from the injury. Despite the immediate hospital care, he developed mediastinitis, were in need of a laparascopy and intensive care. After 8 weeks the stent was removed and the esophagus was considered healed. Biopsies from the esophagus showed an eosinophilic inflammation (65 eosinophils/HPF). Twelve weeks from the injury he was essentially back in his normal state and was discharged from the hospital. He was placed on a 6 weeks course of topical treatment with budesonide, which needed to be extended due to inadequate remission. Remission was achieved after 12 weeks of treatment.ConclusionAn effective topical steroid treatment in EoE patients is important. EoE patients are in risk of oesophageal perforation, if so, management may be conservative but mediastinal drainage is important if significant extravasation occurs and should be instituted from the start.

Ineffective esophageal motility and bolus clearance. A study with combined high-resolution manometry and impedance in asymptomatic controls and patients.

The definition and relevance of ineffective esophageal motility (IEM) remains debated. Our aim was to determine motility patterns and symptoms associated with IEM defined as impaired bolus clearance. To define altered bolus clearance, normal range of swallows with complete bolus transit (CBT) on high-resolution impedance manometry (HRIM) was determined in 44 asymptomatic controls. The results were then applied to a cohort of 81 patients with esophageal symptoms to determine the motility patterns which best predicted altered bolus clearance. Subsequently, in a cohort of 281 consecutive patients the identified motility patterns were compared with patients' customary symptoms. In asymptomatic controls, the normal range of swallows with CBT was 50%-100%. In patients, altered bolus transit (<50% CBT) was only associated with 30% or more failed contractions (P<.001). Neither weak peristalsis nor absence of contraction reserve (CR) was associated with altered bolus clearance. The patterns which best predicted altered bolus clearance were failed contractions ≥30% (specificity 88.2% and sensitivity of 84.6%), and ≥70% ineffective (failed+weak) contractions (sensitivity 84.6% and specificity 80.9%). No motility pattern was correlated to symptom scores. Based on bolus clearance assessed by HRIM, ≥30% failed contractions and ≥70% ineffective contractions have the best sensitivity and specificity to predict altered bolus clearance. Weak contractions and absence of CR are not relevant with respect to bolus clearance.

Conservative management of oesophageal soft food bolus impaction.

Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction. To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus. We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies. We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction. We used standard methodological procedures recommended by Cochrane. We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking. There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.

New parameter for quantifying bolus transit with high-resolution impedance manometry: A comparison with simultaneous esophagogram.

Esophageal bolus transit can be assessed using esophagogram or high-resolution impedance manometry (HRIM). The three-dimensional volume of inverted impedance (VII) has been developed to quantify the residual bolus between each swallow through spatiotemporal analysis. However, this novel metric has not been validated against simultaneous esophagogram. A total of nine healthy volunteers (Seven males, aged 19-45years) were prospectively evaluated with HRIM and barium esophagogram. In addition, 21 symptomatic patients (12 males, aged 20-85years) without major motility disorder were also included. The VII was estimated from HRIM data using MATLAB program and was compared with residual bolus volume in the esophagus estimated from simultaneous esophagogram. A total of 80 swallows (24 in controls and 56 in patients) were analyzed. Results from the VII method were concordant with the bolus transit pattern estimated from the esophagogram in 91.3% (73/80) of swallows. The correlation between quantitative data from VII and the volume of residual bolus estimated from esophagogram was strong in both groups with a Pearson's correlation coefficient of 0.805 for healthy volunteers and 0.730 for symptomatic patients. The intraclass correlation coefficient of VII between the three swallows within a subject was 0.901 in healthy subjects and 0.705 in patients, indicating a modest reliability of this method. The newly developed VII method is a reliable method in assessing residual bolus volume in the esophagus based on comparison with bolus volume estimated from simultaneous esophagogram.

Protocolo diagnóstico de la sensación de globo esofágico

Oesophageal or pharyngeal food bolus obstruction is described as a feeling of tightness or obstruction in the throat. Up to half of the population report compatible symptoms at some point in their life, symptoms that are a frequent reason for consultation. Identifying the underlying cause can be complicated, and even though it is a recognised functional disorder, organic causes should be first ruled out. In the absence of obstructive causes, gastro-oesophageal reflux disease is considered the most common organic cause. The most relevant complementary tests for studying globus pharyngeus are nasal endoscopy, high gastrointestinal endoscopy, pH-metry and high-resolution manometry. Despite the generally benign character of the symptoms, they can entail a significant reduction in the quality of life.

Maturation of Esophageal Motility and Esophagogastric Junction in Preterm Infants

Background: Preterm infants commonly present with oral feeding problems. The role of maturation of esophageal bolus transport mechanisms herein remains unclear. Objectives: To characterize esophageal motility and function of esophagogastric junction (EGJ) during deglutitive swallowing in healthy preterm infants and to describe maturational changes. Methods: Four consecutive high-resolution manometry studies with impedance studies were performed weekly to investigate esophageal motility and EGJ function. Esophageal pressure topography and pressure-impedance metrics were derived. Mixed models with repeated measures were used for statistical analysis. Results: We analyzed 137 nutritive swallows from 36 motility studies in 10 preterm infants. The mean gestational age was 30.17 ± 0.94 weeks; the mean postmenstrual age at time point 1 and 4 was 34.42 ± 0.86 and 37.45 ± 1.16 weeks, respectively. Esophageal peristaltic wave patterns in response to nutritive swallows were observed in all patients. At later time points, esophageal body peristalsis became more rapid, evidenced by a faster distal contractile velocity and shorter distal latency (p = 0.002 and p < 0.0001, respectively). In addition, 4-s integrated relaxation pressures increased and distal contractile integral decreased at later time points (p = 0.003 and p = 0.021, respectively). Bolus clearance also improved at later age (p = 0.008). Conclusions: Preterm infants demonstrate peristaltic esophageal motility following nutritive swallows. However, alterations in esophageal bolus transport in relation to peristalsis are demonstrated. Peristaltic progression becomes more rapid, while deglutitive relaxation pressures increase with increasing age. These maturational changes may suggest further development of the enteric nervous system after birth in former preterm neonates.

Retrospective chart review: seasonal variation in incidence of bolus impaction is maintained and statistically significant in subgroups with atopy and eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition with eosinophilic infiltration of the esophageal mucosa. The most prominent symptom is dysphagia, which may result in esophageal bolus impaction in need of surgical extraction. To investigate whether an earlier reported seasonal variation in esophageal bolus impaction present only in a subgroup of patients with EoE and atopic disorders could be confirmed in this larger study. A single center retrospective chart review of patients who were diagnosed with esophageal bolus impaction between January 2004 and December 2017 was performed. Clinical, epidemiological and histologic data were collected. A total of 755 cases with esophageal bolus impaction were reviewed. A significantly higher occurrence of soft bolus impaction in summer and fall was shown in cases with confirmed EoE and in cases with atopy but not in the nonatopic group or in the group with a negative biopsy result. EoE was found in 48% of biopsied patients. A significant seasonal variation in cases with esophageal bolus impaction and concomitant atopy and EoE is confirmed, but the study design does not allow a causative role of allergens to be established.

AB195. Management of esophageal food bolus obstruction at a university teaching hospital—a retrospective analysis

AB195. Management of esophageal food bolus obstruction at a university teaching hospital—a retrospective analysis