Association between Eosinophilic Esophagitis and Esophageal Food Impaction in the Pediatric Population

Ettyreddy, Abhinav; Sink, Jacquelyn R.; Georg, Matthew W.; Simons, Jeffrey P.

doi:10.1177/0194599818779049

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…12 Our results indicate that the presence of furrows and/or rings in EoE patients is a strong predictor of esophageal food impaction and this population should be treated more aggressively to prevent complications. Our ndings are consistent with a pediatric study showing that the presence of furrows is associated with food impaction, 13 no similar study was found in adult population.…”

Section: Discussionsupporting

confidence: 88%

The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

Alhmoud

Ghazaleh

Ghanim

et al. 2022

Preprint

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Background: Eosinophilic esophagitis (EoE) patients present with dysphagia and often suffer from esophageal food impaction (EFI). EFI can lead to life-threatening perforation, and requires emergent endoscopic intervention. The aim of this study is to evaluate the risk factors for EFI in EoE patients.Methods: This is a retrospective study performed at a tertiary health care system. Medical records and endoscopy images of EoE cases were reviewed. Clinical characteristics and outcomes including EFIs were documented. We used Zip-code median household income as a surrogate for patients’ socioeconomic status.Results: 291 EoE cases were included, mean age was 42 years. Most patients (65%) had classic EoE endoscopic findings including linear furrows and/or concentric rings, however, a significant proportion (47%) had findings suggestive of gastroesophageal reflux disease (GERD), such as the presence of erosive-esophagitis, a hiatal hernia or Schatzki’s ring. 48 patients (16%) developed one or more esophageal food impaction (EFI). The risk of EFI was less likely in the absence of furrows and/or rings; odds ratio (OR) = .28, 95%CI (0.11, 0.72) [P = .008]. Females had less EFI risk; OR = 0.42, 95%CI (0.19, 0.95) [P = .04]. The type of medical insurance and socioeconomic status was not associated with EFI risk.Conclusion: EFI risk is higher in EoE patients with esophageal furrows and/or rings and in men. Aggressive treatment might be required in this population. GERD and EoE can coexist in many patients. Further studies are required to examine the role of the socioeconomic status in EoE complications.

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Section: Discussionsupporting

confidence: 88%

The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

Alhmoud

Ghazaleh

Ghanim

et al. 2022

Preprint

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“…In adolescents, the most common symptoms are dysphagia, heartburn, food impaction and chest pain. The prevalence of EoE among EGDS performed in children with esophageal food impaction and/or dysphagia is high (63-88%) [ 70 - 72 ], so children with these presenting symptoms should be rapidly tested with EGDS and multiple esophageal biopsies. A study [ 43 ] evidenced an increasing prevalence of EoE in patients with dysphagia; moreover, they were more likely to have higher eosinophils peak mucosal counts.…”

Section: Clinical Findingsmentioning

confidence: 99%

Eosinophilic Esophagitis in Children: Clinical Findings and Diagnostic Approach

Matteis

Pagliaro

Corleto

et al. 2020

CPR

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: Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated clinicopathologic disease. During the last 2 decades, the incidence of this condition in children have increased significantly, thanks to more awareness of practitioners and higher use of diagnostic endoscopy. We have analysed paediatric literature on EoE focusing on epidemiology, pathophysiology, clinical findings and diagnostic approach. EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non IgE-mediated reaction to food and/or environmental agents. This leads to esophageal dysfunction and remodeling accompanied by subepithelial ﬁbrosis. EoE presents with a diverse range of gastrointestinal symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal disfunction and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field). In this review we will provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized the relevant aspects of the new clinical condition termed “PPI responsive esophageal eosinophilia”, as entities distinct from EoE and the role of PPI trial in diagnostic workup, therefore we proposed a new diagnostic algorithm.

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“…Gastro-esophageal reflux disease symptoms or vomiting were reported in young children with EoE, whereas older children developed dysphagia and food impaction [3]. In the study of Ettyreddy et al [42] EoE was the most frequent cause for food impaction (in more than 70% of cases).…”

Section: Clinical Manifestationsmentioning

confidence: 96%

Eosinophilic Esophagitis: Diagnosis and Current Management

Surdea-Blaga

Popovici

Stănculete

et al. 2020

JGLD

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Eosinophilic esophagitis (EoE) is an eosinophil-rich, Th2 antigen-mediated disease of increasing worldwideprevalence. Originally considered common in children and young adults, it can be seen at any age, withthe highest prevalence between 30 and 40 years. Symptoms reflect esophageal dysfunction, and typicalendoscopic pictures consist of rings, furrows, exudates and edema. Progressive disease leads to pathologictissue remodeling, with ensuing esophageal rigidity and loss of luminal diameter caused by strictures. Thedefinitive diagnosis is histological (at least 15 eosinophils/HPF, high power field), upper gastrointestinalendoscopy with multiple esophageal biopsies being mandatory. Current therapeutic options include dietaryand pharmacologic treatments. Despite being successful in a high proportion of patients, elemental diet hasmultiple disadvantages. Therefore, a step-up approach (using a two-, four- and six food elimination diets) ispreferred, being globally effective in up to 79% of cases and avoiding unnecessary restrictions. Drug therapyrelies on proton pump inhibitors and topical corticosteroids. Esophageal dilation may be required to increaseluminal patency, leading to immediate symptomatic improvement in 95% of EoE patients, who have stricturesor narrow caliber esophagus. The chronic nature of the disease necessitates long-term therapy. In this review,current diagnostic and treatment options are discussed and a treatment algorithm is proposed.

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Association between Eosinophilic Esophagitis and Esophageal Food Impaction in the Pediatric Population

Cited by 18 publications

References 21 publications

The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

Eosinophilic Esophagitis in Children: Clinical Findings and Diagnostic Approach

Eosinophilic Esophagitis: Diagnosis and Current Management

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