Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 244-247
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.244
Prevalence of eosinophilic oesophagitis in adults presenting with oesophageal food bolus obstruction
Neel Heerasing, Shok Yin Lee, Sina Alexander, Damian Dowling
Neel Heerasing, Department of Gastroenterology, Alfred Hospital, Melbourne, VIC 3004, Australia
Neel Heerasing, Shok Yin Lee, Sina Alexander, Damian Dowling, Department of Gastroenterology, University Hospital Geelong, Geelong, VIC 3220, Australia
Author contributions: Heerasing N and Lee SY contributed equally to the writing of the manuscript as well as analyzing the data; Alexander S and Dowling D provided valuable comments when reviewing the manuscript.
Institutional review board statement: The study was approved by the Barwon Health Ethics Research Committee.
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Neel Heerasing, Department of Gastroenterology, Alfred Hospital, 55 Commercial Road, Prahran, Melbourne, VIC 3004, Australia. neel.heerasing@gmail.com
Telephone: +61-3-90762000 Fax: +61-3-90762757
Received: April 24, 2015
Peer-review started: April 24, 2015
First decision: July 17, 2015
Revised: August 31, 2015
Accepted: October 1, 2015
Article in press: October 8, 2015
Published online: November 6, 2015
Processing time: 202 Days and 1.7 Hours
Abstract

AIM: To look at the relationship between eosinophilic oesophagitis (EO) and food bolus impaction in adults.

METHODS: We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction (FBO) between 2012 and 2014. In this cohort, 96 were adults (64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features: (1) peak eosinophil counts > 20/hpf; (2) eosinophil microabscess; (3) superficial layering of eosinophils; (4) extracellular eosinophil granules; (5) basal cell hyperplasia; (6) dilated intercellular spaces; and (7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis.

RESULTS: Our cohort had a median age of 60. Seventeen/51 (33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male (71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates were found in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies.

CONCLUSION: EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed routinely at index endoscopy in order to pursue this treatable cause of long term morbidity.

Keywords: Oesophagitis, Eosinophilia, Food bolus obstruction, Endoscopy, Dysphagia

Core tip: Eosinophilic oesophagitis (EO) is a clinical entity that is becoming more frequent in patients seeking medical attention for food bolus obstruction (FBO). The main symptom in adult patients is dysphagia. Various studies have shown the presence of EO in 20% to 54% of the patients presenting with food bolus impaction. Approximately one in three patients who presents with FBO has EO. Biopsies should be performed routinely at index endoscopy in order to pursue this treatable cause of long term morbidity.