title: Etiology and management of esophageal food impaction: a population based study.
abstract: OBJECTIVE
  Esophageal food impaction (FI) is a common clinical problem with limited information on incidence. Previous population based studies are lacking. The incidence, main etiological factors, recurrence and outcome of FI was determined in the present study in a population based setting.
  
  
  METHODS
  This was a study of consecutive adult patients who presented with FI from 2008 to 2013 at the National University Hospital of Iceland. The mean crude incidence rate of FI was calculated. Retrospective analysis was undertaken on relevant clinical data such as type of bolus, management, complications, recurrence rate, risk factors for recurrence, and outcome.
  
  
  RESULTS
  Overall 308 patients had endoscopically confirmed FI, males 199/308 (65%), median age 62 years. The mean crude incidence was 25 per 100,000 inhabitants per year. The types of FI was meat (68%), fish (12%), vegetable (4%) and other food/objects (16%). Causes for the FI included: esophageal strictures (45%), hiatal hernia (22%), eosinophilic esophagitis (EoE) (16%) and esophageal carcinoma (2%). Recurrence appeared in 21%, in which 24/48 (50%) had EoE vs. 40/260 (15%) in others (p = 0.0001). The removal of the foreign body was successful in 98% of the cases during the first endoscopy. Endoscopic associated complications included four (1.3%) aspirations, one (0.3%) esophageal perforation and one Boerhaave syndrome at presentation (both had EoE).
  
  
  CONCLUSIONS
  The incidence of FI is the highest reported to date. EoE was strongly associated with recurrence of FI. In a population based setting endoscopy is a safe and effective procedure for removing FI.
authors.affiliation: Department of the Internal Medicine, Division of Gastroenterology and Hepatology, The National University Hospital of Iceland , Reykjavik , Iceland.
authors.forename: Helga M
authors.initials: HM
authors.lastname: Gretarsdottir
authors.forename: Jon Gunnlaugur
authors.initials: JG
authors.lastname: Jonasson
authors.forename: Einar S
authors.initials: ES
authors.lastname: Björnsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology; D019468:Disease Management; D004724:Endoscopy; D057765:Eosinophilic Esophagitis / Q000150:complications*; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D004940:Esophageal Stenosis / Q000150:complications*; D005260:Female; D005502:Food; D005547:Foreign Bodies / Q000628:therapy*; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans; D007055:Iceland; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: dysphagia; eosinophilic esophagitis; food impaction; management