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

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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.

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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

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Authors and Affiliations

  1. Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children’s Hospital, Baylor College of Medicine, 6701, Fannin Street, 1010.00, Houston, TX, 77030, USA

    Girish S. Hiremath, Fatimah Hameed, Ann Pacheco, Anthony Olive′ & Robert J. Shulman

  2. Pediatric Allergy and Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Carla M. Davis

  3. Children’s Nutrition Research Center, Houston, TX, USA

    Robert J. Shulman

Authors
  1. Girish S. Hiremath
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  2. Fatimah Hameed
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  3. Ann Pacheco
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  4. Anthony Olive′
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  5. Carla M. Davis
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Correspondence to Girish S. Hiremath.

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Hiremath, G.S., Hameed, F., Pacheco, A. et al. Esophageal Food Impaction and Eosinophilic Esophagitis: A Retrospective Study, Systematic Review, and Meta-Analysis. Dig Dis Sci 60, 3181–3193 (2015). https://doi.org/10.1007/s10620-015-3723-8

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  • DOI: https://doi.org/10.1007/s10620-015-3723-8

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