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

Methods

Subjects

A retrospective analysis was performed of all patients who were admitted with FBI, from 1996 to 2010, to the Royal Adelaide Hospital, the largest tertiary referral hospital in South Australia. The patients were retrieved from a prospectively collected hospital database, using admission and discharge codes that indicate the diagnosis of FBI. The caring team under which the patients were admitted was also identified.

Data Collection

Detailed data collection relating to the patient's FBI was undertaken only on patients who were admitted under, or endoscoped by, the Department of Gastroenterology, as the unit has kept prospective endoscopic and histological databases of all treated patients. Such databases were not available in the Department of Ear, Nose, and Throat (ENT). The following data were collected from the Gastroenterology cohort: demographics, endoscopic findings, suspected endoscopic diagnosis, mode of bolus disimpaction, tissue acquisition, and histological findings.

Definitions

On upper endoscopy, mucosal changes and esophageal strictures were identified and described. Mucosal changes considered suspicious of EoE included longitudinal furrows, microabscesses, concentric rings, and strictures.[2,3] Strictures were defined as luminal narrowing along the esophagus that, in some circumstances, may prevent further passage of the endoscope. The overlying mucosa could be normal or abnormal. "Malignant strictures" were defined as strictures with abnormal overlying mucosa that biopsies confirmed the presence of neoplasm. For strictures that were defined as "benign or peptic," the overlying mucosa was either normal or inflamed based on endoscopic and/or histological confirmation.

Histology

All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, Royal Adelaide Hospital. The diagnosis of EoE was defined and established by the presence of the following histological features:[2] (i) peak eosinophil counts > 15/hpf; (ii) eosinophil microabscess; (iii) superficial layering of eosinophils; (iv) extracellular eosinophil granules; (v) basal cell hyperplasia; (vi) dilated intercellular spaces; and (vii) subepithelial or lamina propria fibrosis.

Data Analysis

Most data are expressed as mean ± SD. A P < 0.05 was considered as statistically significant in all analyses. Comparison of variables was undertaken using chi-square tests for categorical data, and independent t-test for continuous data sets. Analyses were performed using GraphPad Prism statistical software, version 6 (GraphPad Software Inc., La Jolla, CA, USA). To better map the changing trends, the data were subdivided into three 5-year time frames: 1996–2000, 2001–2005, and 2006–2010.

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