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Original article
Recognising eosinophilic oesophagitis as a cause of food bolus obstruction
  1. Yevedzo Ntuli1,2,
  2. Isabelle Bough1,3,
  3. Michael Wilson4
  1. 1 University of Dundee School of Medicine, University of Dundee, Dundee, UK
  2. 2 Royal London Hospital, London, London, UK
  3. 3 Glasgow Royal Infirmary, Glasgow, Glasgow, UK
  4. 4 General Surgery, Ninewells Hospital, Dundee, UK
  1. Correspondence to Dr Yevedzo Ntuli, University of Dundee School of Medicine, University of Dundee, Dundee SW16 2LH, UK; yevedzontuli{at}gmail.com

Abstract

Background Eosinophilic oesophagitis (EoE) is a chronic, inflammatory condition of the oesophagus, characterised by intermittent dysphagia, food bolus obstruction (FBO) and histologically proven, eosinophil-mediated inflammation. EoE is identified in up to 50% of FBO presentations.

Objective To evaluate the management of patients presenting with FBO to our centre against current clinical guidelines.

Design A retrospective analysis of acute FBO was performed between January 2008 and August 2014. Patients were identified using the ICD 10 code T18.1, ‘foreign body in oesophagus’ in their electronic discharge document. Data were collected on admitting specialty, previous FBO, endoscopy findings, biopsy sites and findings, eosinophil count and diagnosis of EoE.

Results 310 acute episodes of FBO were included in the final study cohort. 202 (65.2%) flexible oesophagogastroduodenoscopies (OGDs) were performed, with 50 (34.5%) of those occurring in those admitted under ENT (n=145), versus 28 (93.3%) and 124 (91.9%) in general medicine (n=30) and surgery (n=135), respectively. 80 (39.6%) had oesophageal biopsies taken, and 21 novel diagnoses of EoE were made (26.3% biopsy-proven rate). Five (23.8%) of the novel diagnoses had a formal eosinophil count included in the histopathology report, and eight (38.1%) had up to three previous OGDs that had not diagnosed their condition of EoE.

Conclusion Our study highlights wide variation in adherence to the guidelines for the management of FBO depending on admitting specialty. We advocate an FBO protocol involving single specialty management, flexible OGD, ≥6 biopsies from the upper and lower oesophagus, and standardisation of oesophageal biopsy reports with a formal eosinophil count.

  • food bolus
  • eosinophilic oesophagitis
  • dysphagia
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Footnotes

  • Presented at A poster for this work was presented at the 2017 Res Medica RMS conference and an abstract for this work published in 2017 Res Medica RMS Conference abstracts. Res Medica. 24(1);107–117. DOI: https://doi.org/10.2218/resmedica.v24i1.2510

  • Contributors YN and IB collected and analysed the data as well as wrote the manuscript. MW provided a supervisory role, reviewed and amended subsequent draft copies of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Research Ethics Committee approval was not required for this study, as confirmed by the decision-making tool on the online National Research Ethics Service. The study was registered with and approved by the local Caldicott guardian.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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