Food bolus impaction in children is nearly always from eosinophilic oesophagitis

Abstract

Introduction: Eosinophilic oesophagitis (EoE) is a chronic, immunemediated oesophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophilpredominant inflammation.1 Incidence and prevalence of this condition is increasing.2 The presentation of EoE varies with age but dysphagia is common in adults and older children.3 We hypothesize that most children requiring endoscopic management of food bolus impaction will have EoE. Methods: Retrospective review of all patients presenting or referred with food bolus impaction to a paediatric hospital between 1st Nov 2011 and 31st Dec 2014 inclusive. ICD-10 codes for endoscopy and removal of foreign body (30478-00, 30478-10) were used to identify patients who required endoscopy. All patients with oesophageal foreign bodies were reviewed but only those with food in the oesophagus were included in the study. EoE was defined as the presence of ≥15 eosinophils/high power field on biopsy in either proximal and/or distal oesophagus.4 Results: 138 endoscopies were performed in 133 children. Oesophageal foreign bodies were noted in 78 procedures of which 76 were performed emergently. Procedures were mainly performed by gastroenterologists (n = 50) and otolaryngologists (n = 23). Common foreign bodies include coins (n = 33), food (n = 22), button battery (n = 3), dental wire (n = 3), and toys (n = 3). 22 endoscopies were performed in 19 patients for food bolus impaction, and histology available in 14/19 (74%) patients. 79% (15/19) of these patients were male and median age at presentation was 12.08 (range 0.85-15.05) years. 79% (11/14) of those biopsied fulfilled histologic criteria for EoE. Interestingly the remaining 3 patients who had biopsies all demonstrated oesophageal eosinophilia although their count (range 3-13 eos/hpf) was insufficient to be diagnostic of EoE. 2/5 patients who did not have biopsies were known to have an oesophageal stricture after previous surgery. Most children presenting with food bolus impaction therefore had underlying oesophageal pathology. Conclusions: Food bolus impaction in children is nearly always a consequence of underlying oesophageal disorder, of which EoE is the most common. We recommend that all children presenting with food bolus impaction have oesophageal biopsies for EoE.L720627112015-11-05 <br />