Eosinophilic esophagitis: Is it a common cause of food impaction?

Abstract

Purpose: The objective of the present study was to examine the incidence and therapeutic options for eosinophilic oesophagitis, which is a condition characterised by eosinophilic infiltration of the oesophagus and has attracted more attention recently as a possible cause of food impaction in the oesophagus.

Patients and Methods: In this study, of the 44 cases admitted to our emergency room with oesophageal food impaction between 2005 and 2010, 28 were found to have histopathologically documented eosinophilic oesophagitis.

Results: Obstruction in the oesophagus caused by food, which is also referred to as “Steakhouse Syndrome”, was associated with a malignancy only in one patient who had a distal oesophageal tumor. Thirty patients had some type of gastrointestinal signs or symptoms including difficult swallowing, nausea, vomitting, or reflux before the occurrence of the event. Mucosal lesions were present in 30 subjects. Samples for biopsy were taken from different oesophageal sites in all patients which showed intense eosinophilic infiltration in 28 patient, with 20 to 30 and >30 eosinophils per high-power field in 12 and 16 patients, respectively.

Conclusion: Eosinophilic infiltration, common in middle-aged Caucasian males, usually presents with retrosternal pain, hypersalivation, and inability to swallow and has emerged as the most common cause of oesophageal food impaction in the present study. We believe that in patients presenting with food impaction physicians should maintain a high index of suspicion for a possible diagnosis of eosinophilic oesophagitis and perform oesophageal biopsy at multiple sites in order to implement an effective treatment.