Oesophageal food bolus obstruction and eosinophilic oesophagitis

Abstract

Eosinophilic oesophagitis (EoE) is now a well‐recognised cause of dysphagia and food bolus obstruction (FBO). The diagnosis requires histologic confirmation, and the yield is greatest when at least 4 to 6 oesophageal biopsies are taken from different sites. Previous case reports of FBO have demonstrated a low biopsy rate, and as such cases of EoE may have been missed. In this review, the medical records of 123 patients aged 18 years or older, who had presented with FBO over a 2 year period, were reviewed. EoE was the most common diagnosis, and was found in 81.3% of patients with FBO aged 40 years or less. 45.5% of patients with FBO were biopsied, and of those, 33.9% were confirmed to have had at least 4 biopsies. EoE is a common cause of FBO and requires appropriate oesophageal sampling to confirm the diagnosis. Cases of EoE may otherwise be missed.

Seasonality of hip fracture and vitamin D deficiency persists in a sub‐tropical climate

“…Factors other than 25-OHD deficiency are clearly involved in the seasonal variation in hip fracture in our cohort. However, wet or icy conditions are unlikely to have contributed, since Brisbane has lower rainfall in winter compared to summer, similar sunshine hours and a mean minimum temperature >9 C. 20 In conclusion, hip fractures are more common in the winter months even in a sub-tropical climate. The prevalence of 25-OHD deficiency in patients presenting with hip fractures during the winter is higher than during the summer, and may be a factor that predisposes to fracture.…”

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

“…However, biopsies were not taken at endoscopy during the index presentation with food bolus obstruction in 73% of these patients. 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.…”

“…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.…”

Pathophysiology of Dysphagia in Eosinophilic Esophagitis: Causes, Consequences, and Management

“…An existing template for esophageal hyposensitivity exists in silent GORD and Barrett's esophagus, where patients have reduced sensitivity to acid exposure and mechanical distention compared to controls [95,96]. Although this has not been directly explored in EoE, hyposensitivity could in part explain the prevalence of FBO as the initial presentation of EoE in the majority of adults rather than non-obstructive dysphagia [5,[97][98][99][100][101]. Cumulative eosinophilic inflammation and the neurotoxic effects of released cytoplasmic granules may eventually lead to sensory neuronal loss or dysfunction, resulting in a reduction in esophageal sensation, particularly in those with a longer duration of disease [74].…”

“…This disorder has become increasingly common in the last two decades, causing significant morbidity for those afflicted as well as healthcare costs to society at large [ 2 , 3 ]. Dysphagia and food bolus obstruction (FBO) events are the most frequent manifestations of EoE such that it is now a leading cause of FBO in older children and adults [ 4 , 5 ]. FBO results in immediate distress, emergency department presentation, and often hospitalization for emergent endoscopy and bolus removal [ 6 , 7 ].…”