Loss to follow-up after food impaction among patients with and without eosinophilic esophagitis

Chang, Joy; Olson, Samuel R.; Kim, Ju Young; Dolan, Russell D.; Greenson, Joel K.; Sanders, Georgiana; Rubenstein, Joel H.

doi:10.1093/dote/doz056

Cited by 31 publications

(26 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 Approximately 50% of patients who present on an emergency basis with an esophageal food impaction requiring endoscopic removal have EoE. 15,16 In patients with EoE, longer periods of untreated inflammation are associated with a higher prevalence of esophageal fibrosis, dysphagia, and food impaction. 17 A cohort study of 721 patients with EoE from the Netherlands reported that in patients with symptoms of EoE for more than 21 years at the time of diagnosis, the proportions of patients with strictures and esophageal food impactions were 52% and 57%, respectively.…”

Section: Clinical Presentationmentioning

confidence: 99%

Eosinophilic Esophagitis

Muir

Falk

2021

JAMA

171

118

View full text Add to dashboard Cite

ImportanceEosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects an estimated 34.4/100 000 people in Europe and North America. EoE affects both children and adults, and causes dysphagia, food impaction of the esophagus, and esophageal strictures.ObservationsEoE is defined by symptoms of esophageal dysfunction, such as vomiting, dysphagia, or feeding difficulties, in a patient with an esophageal biopsy demonstrating at least 15 eosinophils per high-power field in the absence of other conditions associated with esophageal eosinophilia such as gastroesophageal reflux disease or achalasia. Genetic factors and environmental factors, such as exposure to antibiotics early in life, are associated with EoE. Current therapies include proton pump inhibitors; topical steroid preparations, such as fluticasone and budesonide; dietary therapy with amino acid formula or empirical food elimination; and endoscopic dilation. In a systematic review of observational studies that included 1051 patients with EoE, proton pump inhibitor therapy was associated with a histologic response, defined as less than 15 eosinophils per high-power field on endoscopic biopsy, in 41.7% of patients, while placebo was associated with a 13.3% response rate. In a systematic review of 8 randomized trials of 437 patients with EoE, topical corticosteroid treatment was associated with histologic remission in 64.9% of patients compared with 13.3% for placebo. Patients with esophageal narrowing may require dilation. Objective assessment of therapeutic response typically requires endoscopy with biopsy.Conclusions and RelevanceEoE has a prevalence of approximately 34.4/100 000 worldwide. Treatments consist of proton pump inhibitors, topical steroids, elemental diet, and empirical food elimination, with esophageal dilation reserved for patients with symptomatic esophageal narrowing.

show abstract

Section: Clinical Presentationmentioning

confidence: 99%

Eosinophilic Esophagitis

Muir

Falk

2021

JAMA

171

118

View full text Add to dashboard Cite

show abstract

“…43 Finally, in patients presenting as an emergency with food bolus obstruction, if biopsies were not taken, 79% were lost to secondary care follow-up, missing the opportunity to diagnose EoE. 44 Furthermore, in patients who have not had biopsies taken on their index endoscopy when presenting with a food-bolus obstruction, in those in whom a repeat endoscopy can be organised, there is a delay to diagnosis and follow-up of at least 2 years. 38 Biopsy at the time of endoscopy for food bolus obstruction is not associated with an increased risk of oesophageal perforation.…”

Section: Oesophageal Biopsies Should Be Taken At Index Endoscopy In P...mentioning

confidence: 99%

“…In a more recent study, 55% of patients with food bolus obstruction did not have biopsies taken at endoscopy during their first presentation and of those who were biopsied, insufficient biopsies to reliably exclude EoE were taken in 66% of patients 43. Finally, in patients presenting as an emergency with food bolus obstruction, if biopsies were not taken, 79% were lost to secondary care follow-up, missing the opportunity to diagnose EoE 44. Furthermore, in patients who have not had biopsies taken on their index endoscopy when presenting with a food-bolus obstruction, in those in whom a repeat endoscopy can be organised, there is a delay to diagnosis and follow-up of at least 2 years 38…”

Section: Clinical Presentationmentioning

confidence: 99%

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Dhar

Haboubi

Attwood

et al. 2022

Gut

121

View full text Add to dashboard Cite

BackgroundEosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.MethodsThe Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.ResultsFifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.ConclusionsThese comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

show abstract

“…Failure to obtain biopsy samples at the time of impaction necessitates performing an additional endoscopy, which further delays confirmation of the diagnosis and medical treatment with the risk of losing these patients in follow-up. 57 Nevertheless, clinical situations such as patient instability or fear of aspiration during endoscopy may not allow the needed time to procure esophageal biopsy samples.…”

Section: Endoscopic Diagnosis: Biopsymentioning

confidence: 99%