title: Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis.
abstract: BACKGROUND
  The epidemiology of esophageal foreign-body impaction (EFBI) is poorly described, and the impact of the increasing prevalence of eosinophilic esophagitis (EoE) on this is unknown.
  
  
  OBJECTIVE
  To assess the characteristics of patients with EFBI, to determine whether EFBI cases increased in proportion to EoE cases, and to identify predictors of EFBI.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Cases of EFBI from 2002 to 2009 were identified by querying billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision, Clinical Modification code 935.1, "foreign body in the esophagus." Charts were reviewed to confirm EFBI and to extract pertinent data. Cases of EoE were defined per guidelines.
  
  
  RESULTS
  Of 548 patients with EFBI (59% male, 68% white, bimodal age distribution), 482 (88%) required a procedure, 347 (63%) had food impactions, and 51 (9%) had EoE. EFBIs increased over the study time frame, and the number of EGDs performed for EFBI nearly quadrupled. Increasing diagnosis of EoE did not fully account for this trend, but only 27% of patients who underwent EGD had esophageal biopsies. Of patients who underwent biopsy, 46% had EoE. EoE was the strongest predictor of multiple EFBIs (odds ratio 3.5; 95% CI, 1.8-7.0).
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  The number of EGDs performed for EFBI has increased dramatically at our center, but increasing EoE prevalence only partially explains this trend. Because only a minority of EFBI patients underwent biopsies and because nearly half of those who did undergo biopsy had EoE, the incidence of EoE may be substantially underestimated. Physician education is needed to increase the proportion of subjects with EFBI who undergo biopsies.
authors: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors: Sarah L W
authors: SL
authors: Sperry
authors: Seth D
authors: SD
authors: Crockett
authors: C Brock
authors: CB
authors: Miller
authors: Nicholas J
authors: NJ
authors: Shaheen
authors: Evan S
authors: ES
authors: Dellon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000453:epidemiology*; D004947:Esophagus; D005260:Female; D005502:Food / Q000009:adverse effects; D005547:Foreign Bodies / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult