Changing Epidemiology of Food Bolus Impaction

Is Eosinophilic Esophagitis to Blame?

Venkat N Mahesh; Richard H Holloway; Nam Quoc Nguyen

Disclosures

J Gastroenterol Hepatol. 2013;28(6):963-966. 

In This Article

Abstract and Introduction

Abstract

Background and Aim: Data on the relationship between epidemiological changes in food bolus impaction (FBI) and its relationship to eosinophilic esophagitis (EoE) are limited. The aim of this study was to evaluate changes in the prevalence and etiology of FBI at the Royal Adelaide Hospital over 15 years.

Methods: Details of all patients who presented with FBI to Royal Adelaide Hospital (1996–2010) were reviewed from a prospective database. Detailed endoscopic and histological findings were examined for patients admitted under the Gastroenterology team.

Results: From 1996–2010, 539 patients were admitted. Prevalence of FBI increased overtime, with a male preponderance. The age at presentation was significantly lower in 2006–2010 (56.2 ± 1.6 years) compared with 2001–2005 (61.6 ± 1.9 years, P = 0.03). There was a reduction in the proportion of patients with peptic-related stricture (from 75% [1996–2000] to 41% [2006–2010] [P < 0.001]) and an increase in the prevalence of EoE (from 0% [1996–2000] to 35% [2006–2010], P < 0.001). The proportion of patients who had esophageal biopsies taken at the index endoscopy also increased (8% [1996–2000] vs 28% [2001–2005] and 61% [2006–2010], P < 0.01). There were no significant changes in rate of malignancy or post-surgical strictures. Endoscopic removal of food bolus was required in 86% of cases and, of these, 98% were successful with no complication or death.

Conclusions: The prevalence of FBI has increased over the last 15 years. This was associated with an increased prevalence of EoE and a reduction in age of presentation and peptic-related strictures. These findings suggest that EoE is an important cause of FBI and that esophageal mucosal biopsy should be performed in all cases of FBI.

Introduction

Since the first description of eosinophilic esophagitis (EoE) in 1962 by Schreiber,[1] there has been a growing recognition and understanding of this condition. Recently, the task force led by Liacouras et al. provided the conceptual definition of EoE as "a chronic, immune antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.[2]

Data on the epidemiological patterns of EoE are limited. Data from Ohio, Sweden, and Western Australia[3–5] indicate a significant increasing prevalence of this condition over the last two decades. The Australian study in particular, reported a rapidly increasing prevalence of EoE from 0.05 cases per 10 000 children in 1995 to 0.89 per 10 000 in 2004. Available data suggest this increasing prevalence is more likely related to ascertainment bias and an increasing awareness of the condition, rather than a true increase in the incidence of EoE.[6] However, a recent cross-sectional study from The Netherlands, using the nation-wide network and registry of pathology reports describing esophageal eosinophilia from 1996 through 2010, robustly demonstrated an increase in incidence of EoE from 0.01/100 000 persons in 1996 to 1.31/100 000 persons in 2010. The increasing incidence was noted in all age groups, highest among 20–29-year-old males.[7]

Food bolus impaction (FBI) in the esophagus is more commonly seen in elderly patients and most commonly related to reflux-related esophageal diseases and esophageal dysmotility.[8] Although EoE has been reported as an uncommon cause of FBI, a recent study suggests that EoE is becoming a more common cause for FBI, with 14/29 biopsied patients having EoE.[9] Epidemiological data on FBI over the last few decades and its relationship to EoE, however, remain limited. The aim of the current study was to evaluate the changes in prevalence of FBI and to explore the changes in etiology of FBI at the Royal Adelaide Hospital over last 2 decades.

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