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

Results

A total of 539 patients were admitted to the Royal Adelaide Hospital with FBI over 15 years, with 315 patients under the Department of Gastroenterology and 224 patients under the Department of ENT.

Changes in Prevalence and Demographics Over Time

The overall number of FBI progressively and significantly increased over the 15 years (P < 0.001, Fig. 1), despite the lack of changes in the serviced population over the studied period. The increased prevalence of FBI was related mainly to an increased number of referrals to the Department of Gastroenterology (Figs 1,2). The number of referrals to the ENT Unit remained unchanged (Fig. 1).

Figure 1.

The total number of patients who were admitted to the Royal Adelaide Hospital for the management of food bolus impaction (FBI) over the 15 years. Data are stratified according to whether the patients were under the care of ( ) Gastroenterology or ( ) ENT Unit.

Figure 2.

Increasing annual prevalence of patients admitted with food bolus impaction (FBI) under the Gastroenterology Unit at the Royal Adelaide Hospital over 15 years.

For patients who were admitted under Gastroenterology, there was a preponderance of males (2.3:1 ratio), and the male gender preponderance was observed in all time frames (Table 1). While there was no change in gender difference over time, the age of presentation for FBI decreased significantly over the 15-year period of observation (P < 0.01, Table 1).

Etiology of FBI

Based on endoscopic reporting, radiology, and histopathology, there was a significant change in the etiology of FBI over the 15-year period (Fig. 3). The most obvious change was a reduction in the proportion of patient with benign or peptic strictures (including Schatzki's rings), from 75% (1996–2000) to 41% (2006–2010) (P < 0.001, Table 1). Conversely, there was a progressive increase in the proportion of patients with EoE (P < 0.001, Table 1). The prevalence of malignant strictures causing FBI, however, did not change over the 15 years. The proportion of patients who had no abnormality on endoscopy and/or esophageal biopsy also decreased over time. The practice of esophageal mucosal biopsy also changed over time. Significantly more esophageal biopsies were taken in patients who presented with FBI in the last 5 years (P < 0.01; Table 1).

Figure 3.

Changes in the etiology of food bolus impaction (FBI) over 15 years. The main changes were a reduction in acid-related strictures or Schatzki's ring but an increase in eosinophilic esophagitis. , 1996–2000; , 2001–2005; , 2006–2010.

Interventions and Clinical Outcomes

All patients who were admitted under Gastroenterology Unit underwent endoscopy. Of these, food bolus had cleared in 35 (11%) patients. For the rest of the patients, the food bolus was impacted in the proximal esophagus in 15%, mid-esophagus in 21%, and distal esophagus in 51%. Techniques used to disimpact the food bolus were: push alone in 141 (68%), pulling alone in 28 (13.4%), and combined push–pull technique in 39 (18.6%). The effectiveness of endoscopic removal of impacted bolus was 98% (275/280). Of the five (2%) cases where endoscopic removal failed, rigid esophagoscopy was required in one patient for bolus disimpaction. Fortunately, the bolus passed spontaneously in the other four patients within 24 h after endoscopy. There was no perforation or death related to either the endoscopic intervention or impacted bolus.

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