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Published on: May 10, 2024
Foreign body impaction as presentation of eosinophilic esophagitis
Scott Hudson1, Chris Sampson, Harlan R Muntz
1Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City, Utah, USA.
Insights
Pediatric esophageal foreign bodies may indicate eosinophilic esophagitis (EoE). Key indicators include food impaction, older age, male sex, atopy, prior dysphagia, and endoscopic findings, suggesting biopsy for EoE diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Allergy and Immunology
- Otolaryngology
Background:
- Esophageal foreign body is a common pediatric emergency.
- Eosinophilic esophagitis (EoE) is an increasingly recognized underlying cause of esophageal foreign bodies in children.
- Identifying children with esophageal foreign bodies who have underlying EoE is crucial for appropriate management.
Purpose of the Study:
- To identify clinical and endoscopic characteristics associated with eosinophilic esophagitis (EoE) in pediatric patients presenting with esophageal foreign bodies.
- To establish criteria for recommending esophageal mucosal biopsy in this population.
Main Methods:
- Retrospective review of 312 pediatric esophageal foreign bodies requiring operative removal.
- Exclusion of patients >18 years or with prior esophageal surgery/pathology.
- Analysis of clinical data, endoscopic findings, and biopsy results in 271 eligible cases.
Main Results:
- Eighteen of 27 biopsied patients were diagnosed with EoE.
- Factors associated with EoE included: food impaction (89%), older age (mean 12.2 years), male sex (78%), atopic disease (61%), prior esophageal foreign body/dysphagia (83%), and endoscopic abnormalities (100%).
Conclusions:
- Pediatric patients with esophageal foreign bodies presenting with food impaction, older age, male sex, atopy, history of dysphagia, or endoscopic abnormalities should be strongly considered for intraoperative esophageal mucosal biopsy to diagnose underlying eosinophilic esophagitis.
Abstract:
Esophageal foreign body is a frequent pediatric presentation, and eosinophilic esophagitis (EoE) is an important underlying disease. To determine characteristics common in the presentation of esophageal foreign body indicative of underlying EoE and reach a recommendation for the appropriate scenario in which to obtain esophageal mucosal biopsy, 312 pediatric esophageal foreign bodies requiring operative removal were reviewed. Patients older than 18 years or with a known history of esophageal surgery or pathology were excluded. Eligibility criteria were met in 271 cases. Twenty-seven patients were biopsied, and 18 were diagnosed with EoE. The following factors were identified in the EoE population: food impaction (89%), older age (average 12.2 years), male sex (78%), atopic disease (61%), previous esophageal foreign body or frequent dysphagia (83%), and endoscopic abnormalities (100%). These factors are all associated with an underlying diagnosis of EoE, and patients meeting these criteria should be strongly considered for intraoperative esophageal mucosal biopsy.
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