Clinical and Experimental Gastroenterology (Sep 2022)
The Risk of Esophageal Food Impaction in Eosinophilic Esophagitis Patients: The Role of Clinical and Socioeconomic Factors
Abstract
Tarik Alhmoud,1 Sami Ghazaleh,2 Marcel Ghanim,2 Roberta E Redfern3 1Gastroenterology and Hepatology Division, Toledo Hospital, Toledo, OH, USA; 2Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA; 3Clinical Research Department, Toledo Hospital, Toledo, OH, USACorrespondence: Tarik Alhmoud, Gastroenterology and Hepatology Division, Toledo Hospital, ProMedica Digestive Health Care, 5700 Monroe St, Suite 103 Sylvania, Toledo, Ohio, 43560, USA, Tel +1 419 841-3301, Fax +1 419 841-7704, Email [email protected]; [email protected]: Eosinophilic esophagitis (EoE) patients present with dysphagia and often suffer from esophageal food impaction (EFI). EFI can lead to life-threatening perforation, and requires emergent endoscopic intervention. The aim of this study is to evaluate the risk factors for EFI in EoE patients.Methods: This is a retrospective study performed at a tertiary health-care system. Medical records and endoscopy images of EoE cases were reviewed. Clinical characteristics and outcomes including EFIs were documented. We used Zip-code median household income as a surrogate for patients’ socioeconomic status.Results: A total of 291 EoE cases were included, mean age was 42 years. Most patients (65%) had classic EoE endoscopic findings including linear furrows and/or concentric rings; however, a significant proportion (47%) had findings suggestive of gastroesophageal reflux disease (GERD), such as the presence of erosive-esophagitis, a hiatal hernia or Schatzki’s ring. Forty-eight patients (16%) developed one or more esophageal food impaction (EFI). The risk of EFI was less likely in the absence of furrows and/or rings; odds ratio (OR) = 0.28, 95% CI (0.11, 0.72) [P = 0.008]. Females had less EFI risk; OR = 0.42, 95% CI (0.19, 0.95) [P = 0.04]. The type of medical insurance and socioeconomic status was not associated with EFI risk.Conclusion: EFI risk is higher in EoE patients with esophageal furrows and/or rings and in men. Aggressive treatment might be required in this population. GERD and EoE can coexist in many patients. Further studies are required to examine the role of the socioeconomic status in EoE complications.Keywords: eosinophilic esophagitis, food impaction, gastroesophageal reflux disease, linear furrows, felinization
