title: Endoscopic Features and Eosinophil Density Are Associated with Food Impaction in Adults with Esophageal Eosinophilia.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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).
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Shikha
authors.initials: S
authors.lastname: Mangla
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Goldin
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Singal
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Hornick
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Hsu Blatman
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Burakoff
authors.affiliation: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. wwchan@partners.org.|Harvard Medical School, Boston, MA, USA. wwchan@partners.org.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Chan
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D002452:Cell Count; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000209:etiology; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D004804:Eosinophils / Q000473:pathology*; D004940:Esophageal Stenosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006356:Heartburn / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Eosinophil counts; Eosinophilic esophagitis; Erosions; Esophageal rings; Food impaction