Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients.
OBJECTIVE
Eosinophilic esophagitis is a rapidly emerging, chronic inflammatory disorder. Prolonged inflammation evokes structural alterations and a fragile esophageal wall prone to perforation/rupture and food impaction. This report assesses the risk of spontaneously arising and procedure-induced complications and proposes practical recommendations.


METHODS
The Swiss Esophageal Esophagitis Database documented 251 confirmed cases. A chart review identified which patients had required endoscopic bolus removal and/or experienced transmural esophageal perforation/rupture. In addition, a MEDLINE search for "eosinophilic esophagitis" with "esophageal perforation" or "esophageal rupture" was undertaken.


RESULTS
During an 18-year period, 87 patients (34.7%) experienced 134 food impactions requiring flexible (124, 92.5%) or rigid (10, 7.5%) endoscopic bolus removal. Transmural perforation occurred in 20% (2/10) of rigid procedures, and 1 esophageal rupture (Boerhaave's syndrome) was observed.


CONCLUSIONS
Bolus removal by rigid endoscopy is a high-risk procedure and should be avoided in eosinophilic esophagitis patients who require a gentler approach. Whether food impaction and esophageal wall remodeling can be prevented with anti-inflammatory medication is still undetermined. All Boerhaave's syndrome cases should be evaluated for underlying eosinophilic esophagitis.
Straumann
Alex
A
Department of Gastroenterology, Kantonsspital Olten, Olten, Switzerland. alex.straumann@hin.ch
Bussmann
Christian
C
Zuber
Markus
M
Vannini
Simone
S
Simon
Hans-Uwe
HU
Schoepfer
Alain
A
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy; D004802:Eosinophilia / Q000150:complications* / Q000175:diagnosis; D004939:Esophageal Perforation / Q000453:epidemiology / Q000209:etiology*; D004940:Esophageal Stenosis / Q000453:epidemiology / Q000209:etiology*; D004941:Esophagitis / Q000150:complications* / Q000175:diagnosis; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005502:Food; D006801:Humans; D008297:Male; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D013557:Switzerland; D016896:Treatment Outcome