The Incidence of Esophageal Food Impactions and Risk Factors for Recurrence in a Large, Community-Based Healthcare...

Esophageal food bolus impaction (EFBI) is a common gastrointestinal emergency with sparse epidemiologic data. We evaluated the epidemiology and clinical characteristics of EFBI and risk factors for recurrence in a large, community-based integrated healthcare organization.

This is a retrospective study of adults with an emergency department (ED) visit for EFBI between 2010-2024. Patients with EFBI confirmed on endoscopy were identified for subgroup analysis. Annual incidence rates were assessed and trends evaluated using Poisson regression. We characterized patient demographics, endoscopic utilization, and associated diagnoses. We evaluated EFBI recurrence rates and potential risk factors for recurrence utilizing time-to-event survival analysis and multivariable Cox proportional hazards model.

10,146 ED encounters for EFBI among 8,231 unique patients were included, and 3,431 patients had an endoscopy confirming EFBI. Annual incidence rates fluctuated from 14.79 (95% CI: 13.55, 16.12) to 21.52 (95% CI: 19.90, 23.24) per 100,000 during the study period, with an initial rise from 2010-2016 followed by decline from 2016-2024. The proportion of patients requiring endoscopy declined from 52.7% (2010-2014) to 42.3% (2021-2014), as did the incidence of endoscopically confirmed EFBI (8.12 to 6.11 per 100,000 from 2010 to 2024, respectively). The highest 5-year cumulative incidences of recurrence were observed in patients with esophageal malignancy (33.7%), eosinophilic esophagitis or EoE (24.0%), and esophageal stricture (23.4%).

No sustained trends in EFBI incidence were observed from 2010-2024, although the proportion of patients requiring endoscopy slightly declined. EoE and benign esophageal stricture were the most common esophageal diagnoses conferring high disease-specific recurrence rates, underscoring an opportunity to optimize diagnosis and treatment.