Etiology of esophageal food impactions in children

Epidemiology and management of oesophageal coin impaction in children

OBJECTIVE

The epidemiology of oesophageal coin impaction in children is poorly understood. We aimed to assess characteristics of patients with coin impaction and identify predictors of type of coin impacted and management strategies.

METHODS

Cases of coin impaction from 2002 to 2009 were identified by querying a tertiary care centre's billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision code "935.1 - foreign body in the oesophagus." Charts were reviewed to confirm case status and to extract pertinent data.

RESULTS

Of 113 patients with oesophageal coin impaction (55% male; 45% Caucasian; mean age 2.9 years), 65 (58%) swallowed a penny, 85 (80%) had the impaction in the proximal oesophagus, and 103 (91%) required a procedure. Thirty-five (34%) patients had an upper endoscopy performed by a gastroenterologist and 68 (66%) had a laryngoscopy or oesophagoscopy performed by an otolaryngologist. Only 2 minor complications were noted. There was no significant relationship between the coin type and location of impaction, but 99% of cases performed by otolaryngologists were for proximally impacted coins, compared to 49% for gastroenterologists (p<0.001).

CONCLUSIONS

Oesophageal coin impaction disproportionately affected young children and extraction was frequently required. Whilst pennies were the most commonly impacted coin, there were no clear predictors on impaction based on coin type.

Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis

BACKGROUND

The epidemiology of esophageal foreign-body impaction (EFBI) is poorly described, and the impact of the increasing prevalence of eosinophilic esophagitis (EoE) on this is unknown.

OBJECTIVE

To assess the characteristics of patients with EFBI, to determine whether EFBI cases increased in proportion to EoE cases, and to identify predictors of EFBI.

DESIGN

Retrospective study.

SETTING

Tertiary care center.

PATIENTS

Cases of EFBI from 2002 to 2009 were identified by querying billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision, Clinical Modification code 935.1, "foreign body in the esophagus." Charts were reviewed to confirm EFBI and to extract pertinent data. Cases of EoE were defined per guidelines.

RESULTS

Of 548 patients with EFBI (59% male, 68% white, bimodal age distribution), 482 (88%) required a procedure, 347 (63%) had food impactions, and 51 (9%) had EoE. EFBIs increased over the study time frame, and the number of EGDs performed for EFBI nearly quadrupled. Increasing diagnosis of EoE did not fully account for this trend, but only 27% of patients who underwent EGD had esophageal biopsies. Of patients who underwent biopsy, 46% had EoE. EoE was the strongest predictor of multiple EFBIs (odds ratio 3.5; 95% CI, 1.8-7.0).

LIMITATIONS

Retrospective, single-center study.

CONCLUSIONS

The number of EGDs performed for EFBI has increased dramatically at our center, but increasing EoE prevalence only partially explains this trend. Because only a minority of EFBI patients underwent biopsies and because nearly half of those who did undergo biopsy had EoE, the incidence of EoE may be substantially underestimated. Physician education is needed to increase the proportion of subjects with EFBI who undergo biopsies.

Update on clinical and immunological features of eosinophilic gastrointestinal diseases

PURPOSE OF REVIEW

Eosinophilic gastrointestinal diseases (EGIDs) are an increasingly common heterogeneous group of intestinal diseases. The purpose of this review is to present the latest developments in the care of patients with EGIDs and to summarize a growing literature defining the clinical features and mechanistic elements of eosinophils and their complex relationships with the gastrointestinal tract.

RECENT FINDINGS

Recent studies continue to define what constitutes 'normal' and 'abnormal' numbers of eosinophils in the different sections of the gastrointestinal tract. Symptom complexes of EGIDs appear to be related primarily to the mucosal, as opposed to the muscular or serosal, forms of EGIDs. Dissection of the mucosal microenvironment is uncovering a complex array of cells, other than eosinophils, that likely contribute to the inflammatory response associated with EGIDs. Mechanistic studies have identified genetic perturbations (eotaxin-3, thymic stromal lymphopoietin, IL-13, and filaggrin) that may also contribute to the development of the most often encountered and well studied EGID, eosinophilic esophagitis.

SUMMARY

Clinicians should remain aware of EGIDs as a diagnostic possibility for patients with common gastrointestinal symptoms. Additional research is needed to determine mechanistic processes leading to dysfunction associated with eosinophilic gastrointestinal inflammation.