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The clinical predictors of aetiology and complications among 173 patients presenting to the Emergency Department with oesophageal food bolus impaction from 2004–2014
Author(s) -
Sengupta N.,
Tapper E. B.,
Corban C.,
Sommers T.,
Leffler D. A.,
Lembo A. J.
Publication year - 2015
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13237
Subject(s) - medicine , eosinophilic esophagitis , etiology , complication , gastroenterology , emergency department , dysphagia , perforation , endoscopy , high power field , impaction , surgery , disease , materials science , psychiatry , punching , metallurgy , immunohistochemistry
Summary Background Oesophageal food bolus impaction ( OFBI ) is a common gastrointestinal emergency. Aim To describe contemporary aetiologies of OFBI , and variables that may predict eosinophilic esophagitis (EoE) related OFBI as well as complications. Methods Patients presenting to the Emergency Department between 2004 and 2014 with OFBI who underwent oesophagogastroduodenoscopy ( EGD ) were included. Clinical and endoscopic variables, as well as complications, were recorded. Aetiology of OFBI was determined by reviewing endoscopy reports. A diagnosis of EoE was confirmed via pathology (>15 eosinophils/high‐powered field) at the index or follow‐up EGD . Logistic regression was used to report associations of variables and complications. Results Of the 173 patients with OFBI , 139 (80%) had an aetiology recognised, the most frequent being EoE (27%, n = 47), Schatzki's ring (20%, n = 34) and oesophageal stricture (13%, n = 22). Six patients (3%) had oesophageal cancer. Patients with EoE‐related OFBI tended to be younger (42 vs. 69 years, P < 0.001), male (81% vs. 52%, P = 0.001), have a prior history of OFBI (45% vs. 18%, P = 0.001), and present during spring or summer (62% vs. 44%, P = 0.04). Eighteen patients (10%) had a complication associated with OFBI , with 3 (2%) perforations. On multivariate regression, patients with EoE‐related OFBI were not more likely to have a complication ( OR 1.07, P = 0.92), although hypoxia at presentation ( OR 59.7, P = 0.006) was associated with complications. Conclusions Eosinophilic esophagitis accounts for over a quarter of patients with oesophageal food bolus impaction. Overall complication rate was 10%, with a 2% perforation rate. Clinical characteristics of patients with eosinophilic esophagitis differ from other patients with oesophageal food bolus impaction.