Introduction The epidemiology of acute food bolus impaction (FBI) of the oesophagus in adults remains unclear. The incidence of eosinophilic oesophagitis (EE) is increasing and is a well-known cause for FBI. Currently, there are no data on the epidemiological changes in FBI and its relationship to EE.
Aim To evaluate the changes in prevalence and aetiology of FBI of the oesophagus.
Methods Details relating to all patients who presented with FBI to the Department of Gastroenterology at the Royal Adelaide Hospital from 1996 to 2010 were reviewed from a prospective database. The periods were divided into 1996–2000, 2001–2005 and 2006–2010. Detailed endoscopic and histological findings were examined for patients who presented between these periods. Data from coding department were analysed to assess the pattern of presentation and specialties involved.
Results Over 15 years, 248 patients presented with FBI (74% male) to the Gastroenterology department. The prevalence of FBI increased overtime (1996–2000: n=30, 2001–2005: n=80; 2006–2010: n=137). While there was no change in gender, the age of presentation was significantly younger in 2006–2010 (56.2±1.6 yrs) than that from 2001 to 2005 (61.6±1.9 yrs, p=0.03) and 1996–2000 (62.8±3.3 yrs, p<0.01). The predominant causes for FBI between 1996 and 2000 related to benign strictures and complications of reflux disease (64%), and no patient had EE. The diagnosis of EE was suspected during endoscopy in 10% of patients in 2001–2005 and 35% of patients in 2006–2010 (p<0.01). Oesophageal biopsies were taken significantly more frequently in patients who presented with FBI between 2006–2010 (75%) as compared to those in 2001–2005 (47%, p<0.01) and 1996–2000 (12%, p<0.001). Histologically proven EE was found in 6.2% of patients in 2001–2005 and 23% of patients in 2006–2010 (p<0.01). There were no significant changes in other aetiologies overtime (benign strictures, reflux disease, malignancy, or post-surgical strictures). Endoscopic findings of “normal” esophageal structure or mucosa reduced overtime occurred in 23% in 1996–2000, 17% in 2001–2005 and 14% in 2006–2010.
Conclusion The increased prevalence of FBI overtime is associated with an increased prevalence of eosinophilic oesophagitis. While this may be related, increasing awareness about eosinophilic oesophagitis and lower threshold for performing esophageal biopsy are also likely to contribute.
Competing interests None declared.