Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis.
OBJECTIVE
To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation.


BACKGROUND
Esophageal perforation is a serious complication of EoE.


METHODS
We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation.


RESULTS
Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair.


CONCLUSIONS
Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.
*Department of Medicine ‡Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology †Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
Thomas M
TM
Runge
Swathi
S
Eluri
Cary C
CC
Cotton
Caitlin M
CM
Burk
John T
JT
Woosley
Nicholas J
NJ
Shaheen
Evan S
ES
Dellon
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001466:Barium Sulfate / Q000008:administration & dosage; D016009:Chi-Square Distribution; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D003287:Contrast Media; D001466:Barium Sulfate
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