Management of Esophageal Food Impaction Varies Among Gastroenterologists and Affects Identification of Eosinophilic Esophagitis

Girish Hiremath, Michael F. Vaezi, Sandeep Gupta, Sari Acra, Evan S. Dellon

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background and Aims: Esophageal food impaction (EFI) is a gastrointestinal emergency requiring immediate evaluation in the emergency room (ER) and an esophagogastroduodenoscopy (EGD) for disimpaction. EFI is also a distinct presenting feature of eosinophilic esophagitis (EoE). This study aimed at understanding the management of EFI among gastroenterologists (GIs) and estimated its impact on identification of EoE in USA. Methods: GIs associated with three major gastroenterology societies based in USA were invited to participate in a web-based survey. Information on the resources available and utilized, and the clinical decision-making process related to management of EFI cases was collected and analyzed. Results: Of 428 responses, 49% were from pediatric GIs, 86% practiced in the USA, and 78% practiced in an academic setting. Compared to the pediatric GIs, adult GIs were more likely to perform EGD in the emergency room [OR 87.96 (25.43–304.16)] and advance the food bolus into stomach [5.58 (3.08–10.12)]. Only 34% of respondents obtained esophageal biopsies during EGD, and pediatric GIs were more likely to obtain esophageal biopsies [3.49 (1.12–10.84)] compared to adult GIs. In USA, by our conservative estimates, 10,494 patients presenting to ER with EFI and at risk of EoE are likely being missed each year. Conclusions: EFI management varies substantially among GIs associated with three major gastroenterology societies in USA. Based on their practice patterns, the GIs in USA are likely to miss numerous EoE patients presenting to ER with EFI. Our findings highlight the need for developing and disseminating evidence-based EFI management practice guidelines.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalDigestive Diseases and Sciences
DOIs
StateAccepted/In press - Feb 20 2018
Externally publishedYes

Fingerprint

Eosinophilic Esophagitis
Food
Digestive System Endoscopy
Hospital Emergency Service
Gastroenterology
Pediatrics
Biopsy
Gastroenterologists
Practice Guidelines
Stomach
Emergencies

Keywords

  • Eosinophilic esophagitis
  • Esophageal food impaction
  • Gastroenterologists
  • Practice patterns

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Management of Esophageal Food Impaction Varies Among Gastroenterologists and Affects Identification of Eosinophilic Esophagitis. / Hiremath, Girish; Vaezi, Michael F.; Gupta, Sandeep; Acra, Sari; Dellon, Evan S.

In: Digestive Diseases and Sciences, 20.02.2018, p. 1-10.

Research output: Contribution to journalArticle

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abstract = "Background and Aims: Esophageal food impaction (EFI) is a gastrointestinal emergency requiring immediate evaluation in the emergency room (ER) and an esophagogastroduodenoscopy (EGD) for disimpaction. EFI is also a distinct presenting feature of eosinophilic esophagitis (EoE). This study aimed at understanding the management of EFI among gastroenterologists (GIs) and estimated its impact on identification of EoE in USA. Methods: GIs associated with three major gastroenterology societies based in USA were invited to participate in a web-based survey. Information on the resources available and utilized, and the clinical decision-making process related to management of EFI cases was collected and analyzed. Results: Of 428 responses, 49{\%} were from pediatric GIs, 86{\%} practiced in the USA, and 78{\%} practiced in an academic setting. Compared to the pediatric GIs, adult GIs were more likely to perform EGD in the emergency room [OR 87.96 (25.43–304.16)] and advance the food bolus into stomach [5.58 (3.08–10.12)]. Only 34{\%} of respondents obtained esophageal biopsies during EGD, and pediatric GIs were more likely to obtain esophageal biopsies [3.49 (1.12–10.84)] compared to adult GIs. In USA, by our conservative estimates, 10,494 patients presenting to ER with EFI and at risk of EoE are likely being missed each year. Conclusions: EFI management varies substantially among GIs associated with three major gastroenterology societies in USA. Based on their practice patterns, the GIs in USA are likely to miss numerous EoE patients presenting to ER with EFI. Our findings highlight the need for developing and disseminating evidence-based EFI management practice guidelines.",
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