Eosinophilic Esophagitis and Food Impaction

Epidemiology and Prevalence

Eosinophilic esophagitis (EoE) is the most common cause of food impaction in the esophagus, accounting for up to 46% of cases requiring endoscopic intervention, according to the American Gastroenterological Association 1
Among patients with EoE, food impaction is extremely common, with prevalence rates ranging from 30% to 55% in adult patients, as reported by the American Academy of Allergy, Asthma, and Immunology 2, 3
Studies examining patients presenting with food impaction have found that 11% to 55% demonstrate EoE as the underlying cause, according to the American Academy of Allergy, Asthma, and Immunology 2, 3

EoE causes inflammation and fibrosis of the esophagus, leading to esophageal rings and strictures that narrow the lumen, as well as reduced esophageal distensibility and impaired esophageal motility, according to the European Society of Gastrointestinal Endoscopy 2, 3, 4
These changes create anatomical and functional narrowing that predisposes to food bolus impaction, as reported by the American Gastroenterological Association 2, 3

For patients presenting with food impaction, at least 6 biopsies from different anatomical sites in the esophagus should be obtained during the index endoscopy, as recommended by the British Society of Gastroenterology 1, 4
If proton pump inhibitors (PPIs) have been used, they should be withdrawn for at least 3 weeks before diagnostic endoscopy to avoid masking EoE, according to the European Society of Gastrointestinal Endoscopy 4

Emergent flexible endoscopy (within 2-6 hours) is recommended for complete esophageal obstruction, as suggested by the World Society of Emergency Surgery 1, 5
Following successful disimpaction, patients should be evaluated for underlying EoE and other esophageal disorders, as recommended by the American Gastroenterological Association 1, 4
Maintenance therapy with topical steroids significantly reduces the risk of recurrent food impaction in patients with EoE, according to the European Society of Gastrointestinal Endoscopy 4