Foreign Body Impaction as Presentation of Eosinophilic Esophagitis

Abstract

Esophageal foreign body is a frequent pediatric presentation, and eosinophilic esophagitis (EoE) is an important underlying disease. To determine characteristics common in the presentation of esophageal foreign body indicative of underlying EoE and reach a recommendation for the appropriate scenario in which to obtain esophageal mucosal biopsy, 312 pediatric esophageal foreign bodies requiring operative removal were reviewed. Patients older than 18 years or with a known history of esophageal surgery or pathology were excluded. Eligibility criteria were met in 271 cases. Twenty-seven patients were biopsied, and 18 were diagnosed with EoE. The following factors were identified in the EoE population: food impaction (89%), older age (average 12.2 years), male sex (78%), atopic disease (61%), previous esophageal foreign body or frequent dysphagia (83%), and endoscopic abnormalities (100%). These factors are all associated with an underlying diagnosis of EoE, and patients meeting these criteria should be strongly considered for intraoperative esophageal mucosal biopsy.

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

“…Of the 30 of 35 patients who had a biopsy conducted, 26 (87%) were diagnosed with EoE. Despite this limitation, our study has one of the highest biopsy rates (83%) compared to similar EFI studies; this high biopsy rate represents a major strength of our analysis 9,10,17,18 . In particular, a recent study by Hudson et al 17 examined all patients with esophageal foreign body impactions to identify those with an underlying diagnosis of EoE.…”

Esophageal Food Impaction and Eosinophilic Esophagitis: A Retrospective Study, Systematic Review, and Meta-Analysis

“…There is an increasing awareness that EFI and symptoms suggestive of esophageal dysfunction can be the initial presentation of eosinophilic esophagitis (EoE) [2, 3]. …”

Eosinophilic oesophagitis: a systematic review for otolaryngologists

“…We selected 1 Cochrane review, 21 6 meta-analyses, 14 , 22 – 26 11 systematic reviews, 1 – 3 , 12 , 18 , 27 – 32 12 non-systematic reviews, 16 , 17 , 33 – 42 11 randomised trials, 43 – 53 15 other controlled trials, 54 – 68 58 case series and cohort studies, 4 – 8 , 10 , 11 , 13 , 15 , 19 , 20 , 69 – 115 1 qualitative study, 116 1 case report, 117 1 published guideline, 118 and 5 published abstracts 9 , 119 – 122 . Eighteen of these articles were selected from the otolaryngology literature 17 – 20 , 32 , 40 , 60 , 95 , 103 – 110 , 112 , 117 …”

“…found eosinophilic oesophagitis more prevalent in food bolus obstruction cases, yet ENT departments never performed mucosal biopsies (despite eosinophilic oesophagitis being involved in 25 per cent of 572 cases of paediatric food bolus obstruction retrieval). One ENT series identified 18 cases of eosinophilic oesophagitis in 27 patients biopsied, from a series of 271 paediatric food bolus obstruction cases 112 …”