1
|
Terkelsen JH, Hollænder M, Bredal K, Nielsen SM, Thomsen KVK, Baggerman A, Ofverlind E, Koc AM, Pakes H, Mahdi MB, Larsen SØ, Gonzalez VP, Riis J, Frandsen LT, Melgaard D, Krarup AL. A retrospective cohort study on oesophageal food bolus obstruction in the North Denmark region in 2021-two thirds were never diagnosed with a cause. BMC Gastroenterol 2024; 24:3. [PMID: 38166672 PMCID: PMC10759704 DOI: 10.1186/s12876-023-03077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). AIMS The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. METHODS Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. RESULTS The median patient age was 66.0 (Q1-Q3: 49.8-81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. CONCLUSIONS Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.
Collapse
Affiliation(s)
| | - Martin Hollænder
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Kasper Bredal
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | | | - Kristoffer Vittrup Koed Thomsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Amanda Baggerman
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Emilia Ofverlind
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Alptug Mertcan Koc
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Hannah Pakes
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Marco Bassam Mahdi
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Sanne Ørnfeldt Larsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Vanessa Parra Gonzalez
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Johannes Riis
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Line Tegtmeier Frandsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- Department of Gastroenterology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Dorte Melgaard
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Lund Krarup
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
2
|
Patel HS, Reji M, Krishnaswamy G. Acute food impaction in an adult with previously undiagnosed eosinophilic esophagitis. CMAJ 2023; 195:E234-E235. [PMID: 36781191 PMCID: PMC9928444 DOI: 10.1503/cmaj.221054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
| | | | - Guha Krishnaswamy
- Department of Internal Medicine (Patel, Reji, Krishnaswamy), Wake Forest School of Medicine; Department of Medicine (Krishnaswamy), Division of Allergy, Immunology and Pulmonary, and Division of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, NC; W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center and Affiliated Institutions (Krishnaswamy), Salisbury and Kernersville, NC
| |
Collapse
|