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Digestive Diseases and Sciences

, Volume 60, Issue 11, pp 3181–3193 | Cite as

Esophageal Food Impaction and Eosinophilic Esophagitis: A Retrospective Study, Systematic Review, and Meta-Analysis

  • Girish S. Hiremath
  • Fatimah Hameed
  • Ann Pacheco
  • Anthony Olive′
  • Carla M. Davis
  • Robert J. Shulman
Review

Abstract

Background

Esophageal food impaction (EFI) can be the initial presentation of eosinophilic esophagitis (EoE). EoE is characterized by persistent esophageal eosinophilia (EE). Both EFI and EE are related to a variety of conditions. To date, the relationship between EFI, EE, and EoE remains unclear.

Aims

To review our institutional experience with EFIs and combine our knowledge with the existing literature to conduct a systematic review and meta-analysis for delineating the relationship between EFI, EE, and EoE.

Methods

We reviewed medical records of 72 children with EFI presenting to our emergency center between 2007 and 2013. PubMed, EMBASE, and Scopus databases were screened from inception until July 2014 to identify studies linking EFI and EoE. Included studies were methodically assessed for the quality and strength of association between EFI and EoE.

Results

Our institutional experience highlighted the possibility of proton-pump inhibitor therapy-responsive EE (PPI-REE) as an underrecognized risk factor for EFI. A systematic review of 14 studies, including ours, revealed that most studies did not eliminate other causes of EFI or EE. The meta-analysis revealed that esophageal biopsies were obtained from 54 % (40–68) of individuals presenting with EFI, and the overall EoE-attributable EFI among those who were biopsied was 54 % (43–65). Substantial heterogeneity was noted among the studies.

Discussion

PPI-REE is an underestimated risk factor for EFI. The quality of existing evidence linking EFI and EoE is limited by several important factors. Future studies with robust design are warranted to delineate the relationship between EFI, EE, and EoE.

Keywords

Eosinophilic esophagitis Dysphagia Epidemiology Meta-analysis 

Notes

Acknowledgments

G.H. is supported by NIH Training Grant (T32 DK007664). The support of the Texas Medical Center Digestive Disease Center (P30 DK56338) also is acknowledged.

Conflict of interest

None.

Supplementary material

10620_2015_3723_MOESM1_ESM.docx (597 kb)
Supplementary material 1 (DOCX 8285 kb)

References

  1. 1.
    Crockett SD, Sperry SL, Miller CB, et al. Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization. Dis Esophagus. 2013;26:105–112.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Hudson S, Sampson C, Muntz HR, et al. Foreign body impaction as presentation of eosinophilic esophagitis. Otolaryngol Head Neck Surg. 2013;149:679–681.CrossRefPubMedGoogle Scholar
  3. 3.
    Mahesh VN, Holloway RH, Nguyen NQ. Changing epidemiology of food bolus impaction: is eosinophilic esophagitis to blame? J Gastroenterol Hepatol. 2013;28:963–966.CrossRefPubMedGoogle Scholar
  4. 4.
    Shi YN, Sun SJ, Xiong LS, et al. Prevalence, clinical manifestations and endoscopic features of eosinophilic esophagitis: a pathological review in China. J Dig Dis. 2012;13:304–309.CrossRefPubMedGoogle Scholar
  5. 5.
    Vindigni C, Villanacci V, Marini M, et al. Eosinophilic esophagitis: an Italian experience. Rev Esp Enferm Dig. 2010;102:15–19.CrossRefPubMedGoogle Scholar
  6. 6.
    O’Donnell S, Kelly OB, Breslin N, et al. Eosinophilic oesophagitis: an Irish experience. Eur J Gastroenterol Hepatol. 2011;23:1116–1121.CrossRefPubMedGoogle Scholar
  7. 7.
    Jensen ET, Kappelman MD, Martin CF, et al. Health-care utilization, costs, and the burden of disease related to eosinophilic esophagitis in the United States. Am J Gastroenterol. 2015;110:626–632.CrossRefPubMedGoogle Scholar
  8. 8.
    Dellon ES. Epidemiology of eosinophilic esophagitis. Gastroenterol Clin North Am. 2014;43:201–218.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Molina-Infante J, Rivas MD, Hernandez-Alonso M, et al. Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression. Aliment Pharmacol Ther. 2014;40:955–965.CrossRefPubMedGoogle Scholar
  10. 10.
    Wen T, Dellon ES, Moawad FJ, et al. Transcriptome analysis of proton pump inhibitor-responsive esophageal eosinophilia reveals proton pump inhibitor-reversible allergic inflammation. J Allergy Clin Immunol. 2015;135:187.e4–197.e4.CrossRefGoogle Scholar
  11. 11.
    Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123:A12–A13.PubMedGoogle Scholar
  12. 12.
    Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–2012.CrossRefPubMedGoogle Scholar
  13. 13.
    Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–1101.CrossRefPubMedGoogle Scholar
  15. 15.
    Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3.e6–20.e6. quiz 21-2.CrossRefGoogle Scholar
  17. 17.
    Lao J, Bostwick HE, Berezin S, et al. Esophageal food impaction in children. Pediatr Emerg Care. 2003;19:402–407.CrossRefPubMedGoogle Scholar
  18. 18.
    Sperry SL, Crockett SD, Miller CB, et al. Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis. Gastrointest Endosc. 2011;74:985–991.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr. 2011;52:43–46.CrossRefPubMedGoogle Scholar
  20. 20.
    Desai TK, Stecevic V, Chang CH, et al. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc. 2005;61:795–801.CrossRefPubMedGoogle Scholar
  21. 21.
    Kerlin P, Jones D, Remedios M, et al. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol. 2007;41:356–361.CrossRefPubMedGoogle Scholar
  22. 22.
    Dellon ES, Kim HP, Sperry SL, et al. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014;79:577.e4–585.e4.CrossRefGoogle Scholar
  23. 23.
    Schoepfer AM, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145:1230–1236. e1-2.CrossRefPubMedGoogle Scholar
  24. 24.
    Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133:1342–1363.CrossRefPubMedGoogle Scholar
  25. 25.
    Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108:679–692. quiz 693.CrossRefPubMedGoogle Scholar
  26. 26.
    Nielsen JA, Lager DJ, Lewin M, et al. The optimal number of biopsy fragments to establish a morphologic diagnosis of eosinophilic esophagitis. Am J Gastroenterol. 2014;109:515–520.CrossRefPubMedGoogle Scholar
  27. 27.
    Gorter RR, Heij HA, van der Voorn JP, et al. Eosinophilic esophagitis after esophageal atresia: is there an association? Case presentation and literature review. J Pediatr Surg. 2012;47:e9–e13.CrossRefPubMedGoogle Scholar
  28. 28.
    Oliveira C, Zamakhshary M, Marcon P, et al. Eosinophilic esophagitis and intermediate esophagitis after tracheoesophageal fistula repair: a case series. J Pediatr Surg. 2008;43:810–814.CrossRefPubMedGoogle Scholar
  29. 29.
    Mandaliya R, DiMarino AJ, Cohen S. Association of achalasia and eosinophilic esophagitis. Indian J Gastroenterol. 2013;32:54–57.CrossRefPubMedGoogle Scholar
  30. 30.
    Wennervaldt K, Melchiors J. Risk of perforation using rigid oesophagoscopy in the distal part of oesophagus. Dan Med J. 2012;59:A4528.PubMedGoogle Scholar
  31. 31.
    Byrne KR, Panagiotakis PH, Hilden K, et al. Retrospective analysis of esophageal food impaction: differences in etiology by age and gender. Dig Dis Sci. 2007;52:717–721.CrossRefPubMedGoogle Scholar
  32. 32.
    Vannelli PM, Youssef NN, Oppenheimer JJ, et al. Exploring the link between eosinophilic esophagitis and esophageal foreign bodies in the pediatric population. Pract Gastroenterol. 2007;31:81.Google Scholar
  33. 33.
    Kirchner GI, Zuber-Jerger I, Endlicher E, et al. Causes of bolus impaction in the esophagus. Surg Endosc. 2011;25:3170–3174.CrossRefPubMedGoogle Scholar
  34. 34.
    Antoniou D, Christopoulos-Geroulanos G. Management of foreign body ingestion and food bolus impaction in children: a retrospective analysis of 675 cases. Turk J Pediatr. 2011;53:381–387.PubMedGoogle Scholar
  35. 35.
    Diniz LO, Towbin AJ. Causes of esophageal food bolus impaction in the pediatric population. Dig Dis Sci. 2012;57:690–693.CrossRefPubMedGoogle Scholar
  36. 36.
    El-Matary W, El-Hakim H, Popel J. Eosinophilic esophagitis in children needing emergency endoscopy for foreign body and food bolus impaction. Pediatr Emerg Care. 2012;28:611–613.CrossRefPubMedGoogle Scholar
  37. 37.
    Williams P, Jameson S, Bishop P, et al. Esophageal foreign bodies and eosinophilic esophagitis—the need for esophageal mucosal biopsy: a 12-year survey across pediatric subspecialties. Surg Endosc. 2013;27:2216–2220.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Girish S. Hiremath
    • 1
  • Fatimah Hameed
    • 1
  • Ann Pacheco
    • 1
  • Anthony Olive′
    • 1
  • Carla M. Davis
    • 2
  • Robert J. Shulman
    • 1
    • 3
  1. 1.Pediatric Gastroenterology, Hepatology and NutritionTexas Children’s Hospital, Baylor College of MedicineHoustonUSA
  2. 2.Pediatric Allergy and ImmunologyTexas Children’s Hospital, Baylor College of MedicineHoustonUSA
  3. 3.Children’s Nutrition Research CenterHoustonUSA

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