Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Features and Eosinophil Density Are Associated with Food Impaction in Adults with Esophageal Eosinophilia

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Food impaction has been described in both eosinophilic esophagitis and proton pump inhibitor-responsive esophageal eosinophilia. The association between endoscopic/histologic features of esophageal eosinophilia and food impaction remains unclear. We aimed to identify clinical, endoscopic, and histologic findings associated with a history of food impaction in esophageal eosinophilia.

Methods

This was a retrospective cohort study of adult esophageal eosinophilia patients at a tertiary center in 6/2005–10/2014. Only patients with ≥15 eosinophils/high-power field on mucosal biopsies were included. Demographics, comorbidities, symptoms, endoscopic/histologic findings on initial endoscopy, and history of food impaction were reviewed. Statistical analyses were performed using Fisher’s exact test (univariate) and forward stepwise logistic regression (multivariate).

Results

400 patients (42 ± 14 years, 61 % male) were included, with 78 (20 %) having food impaction history. On univariate analyses, rings (62 vs 42 %, p = 0.003), erosions (12 vs 5 %, p = 0.03), eosinophil density on biopsy (40 [IQR = 30–50] vs 30 [IQR = 15–50], p = 0.004), and dysphagia (88 vs 62 %, p < 0.0001) were more prevalent among patients with food impaction history, while heartburn (10 vs 33 %, p < 0.0001) and abdominal pain (1 vs 12 %, p = 0.002) were less common. On multivariate analysis, rings (OR 2.6, p = 0.002), erosions (OR 3.2, p = 0.02), and eosinophil density (β-coefficient = 0.01, p = 0.04) remained associated with food impaction.

Conclusions

Findings of rings and erosions on endoscopy and increased eosinophil density on histology were independently associated with a history of food impaction in adult esophageal eosinophilia patients. Food impaction may result from both active inflammation (erosions and increased eosinophil density) and chronic fibrostenotic changes (rings).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. 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.

    Article  PubMed  Google Scholar 

  2. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3–20.

    Article  PubMed  Google Scholar 

  3. Dellon ES. Diagnosis and management of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2012;10:1066–1078.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc. 2005;61:795–801.

    Article  PubMed  Google Scholar 

  5. Straumann A, Bussmann C, Zuber M, Vannini S, Simon HU, Schoepfer A. Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients. Clin Gastroenterol Hepatol. 2008;6:598–600.

    Article  PubMed  Google Scholar 

  6. Dellon ES, Speck O, Woodward K, et al. Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study. Am J Gastroenterol. 2013;108:1854–1860.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Moawad FJ, Schoepfer AM, Safroneeva E, et al. Eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia have similar clinical, endoscopic and histological findings. Aliment Pharmacol Ther. 2014;39:603–608.

    Article  CAS  PubMed  Google Scholar 

  8. Hiremath GS, Hameed F, Pacheco A, Olive A, Davis CM, Shulman RJ. Esophageal food impaction and eosinophilic esophagitis: a retrospective study, systematic review, and meta-analysis. Dig Dis Sci. 2015;60:3181–3193.

    Article  PubMed  Google Scholar 

  9. Aceves SS, Newbury RO, Dohil R, Bastian JF, Broide DH. Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol. 2007;119:206–212.

    Article  CAS  PubMed  Google Scholar 

  10. Nicodème F, Hirano I, Chen J, et al. Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2013;11:1101–1107.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mueller S, Aigner T, Neureiter D, Stolte M. Eosinophil infiltration and degranulation in oesophageal mucosa from adult patients with eosinophilic oesophagitis: a retrospective and comparative study on pathological biopsy. J Clin Pathol. 2006;59:1175–1180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Vasilopoulos S, Murphy P, Auerbach A, et al. The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis. Gastrointest Endosc. 2002;55:99–106.

    Article  PubMed  Google Scholar 

  13. Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003;125:1660–1669.

    Article  PubMed  Google Scholar 

  14. Pasha SF, DiBaise JK, Kim HJ, et al. Patient characteristics, clinical, endoscopic, and histologic findings in adult eosinophilic esophagitis: a case series and systematic review of the medical literature. Dis Esophagus. 2007;20:311–319.

    Article  CAS  PubMed  Google Scholar 

  15. Hudson S, Sampson C, Muntz HR, Jackson WD, Smith ME. Foreign body impaction as presentation of eosinophilic esophagitis. Otolaryngol Head Neck Surg. 2013;149:679–681.

    Article  PubMed  Google Scholar 

  16. Straumann A, Rossi L, Simon HU, Heer P, Spichtin HP, Beglinger C. Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis? Gastrointest Endosc. 2003;57:407–412.

    Article  PubMed  Google Scholar 

  17. Parfitt JR, Gregor JC, Suskin NG, Jawa HA, Driman DK. Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients. Mod Pathol. 2006;19:90–96.

    Article  PubMed  Google Scholar 

  18. Kwiatek MA, Hirano I, Kahrilas PJ, Rothe J, Luger D, Pandolfino JE. Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology. 2011;140:82–90.

    Article  PubMed  Google Scholar 

  19. Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62:489–495.

    Article  PubMed  Google Scholar 

  20. Hirano I. Therapeutic end points in eosinophilic esophagitis: is elimination of esophageal eosinophils enough? Clin Gastroenterol Hepatol. 2012;10:750–752.

    Article  PubMed  Google Scholar 

Download references

Author contributions

WWC, SM, and AHG initiated study concepts and design; SM, AHG, and JLH contributed to acquisition of data; WWC, SM, AHG, GS, KSH, and RB performed analysis and interpretation of data; WWC, SM, and AHG drafted the manuscript; WWC, SM, AHG, GS, JLH, KSH, and RB contributed to critical revision of manuscript for important intellectual content; WWC, SM, AHG, and GS performed statistical analyses; WWC provided administrative support and overall study supervision.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Shikha Mangla, Alison H. Goldin, Robert Burakoff & Walter W. Chan

  2. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Gaurav Singal

  3. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Jason L. Hornick

  4. Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA

    Karen S. Hsu Blatman

  5. Harvard Medical School, Boston, MA, USA

    Shikha Mangla, Alison H. Goldin, Gaurav Singal, Jason L. Hornick, Karen S. Hsu Blatman, Robert Burakoff & Walter W. Chan

Authors
  1. Shikha Mangla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alison H. Goldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaurav Singal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jason L. Hornick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen S. Hsu Blatman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Burakoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Walter W. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Walter W. Chan.

Ethics declarations

Conflict of interest

The authors have nothing to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mangla, S., Goldin, A.H., Singal, G. et al. Endoscopic Features and Eosinophil Density Are Associated with Food Impaction in Adults with Esophageal Eosinophilia. Dig Dis Sci 61, 2578–2584 (2016). https://doi.org/10.1007/s10620-016-4190-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-016-4190-6

Keywords

Search

Navigation