Differences in Presentation and Outcomes by Type and Severity of Food Impaction Symptoms in Eosinophilic Esophagitis

Esophageal food impaction (EFI) commonly occurs in eosinophilic esophagitis (EoE), but its spectrum of severity remains incompletely described.

To determine whether presentation and outcomes of EoE differ based on type of EFI.

Patients with newly diagnosed EoE were categorized by EFI type: those with transient symptoms, those with an emergency department (ED) visit but no esophagogastroduodenoscopy (EGD), and those with an ED visit and EGD. Patient, EoE, and treatment data were collected. We compared characteristics and treatment responses and used multinomial logistic regression to adjust for confounders.

Of 814 EFI patients with EoE, 485 had transient symptoms (symptoms-only), 76 required only an ED visit (ED-only), and 253 required an ED visit and EGD (ED + EGD). Compared to symptoms-only, ED-only and ED + EGD were more likely to have rings (67% and 70% vs 57%; p < 0.001) and stricture (41% and 44% vs 35%; p = 0.04). Topical corticosteroid (tCS) therapy led to histologic response (< 15 eos/hpf) more commonly in the symptoms-only group, followed by ED + EGD and ED-only (61% vs 52% vs 34%; p = 0.009). After tCS therapy, patients with only symptoms were less likely to have narrowing or require dilation. All EFI groups had similar responses to dietary therapy.

In EoE patients, most EFI symptoms self-resolved. Patients requiring at least an ED visit had more fibrostenosis at baseline, less histologic response with tCS therapy, and more persistent fibrostenosis after tCS therapy. Patients with more severe EFI presentations warrant close monitoring and endoscopic management of fibrostenotic disease.