Exploring the link between eosinophilic esophagitis and esophageal foreign bodies in the pediatric population

Eosinophilic esophagitis (EE) has a clinical presentation similar to gastroesophageal reflux disease but is often refractory to acid suppressing medications and patients often continue to be symptomatic. In addition, acute dysphagia associated with food impaction of the esophagus has been reported to be associated with eosinophilic esophagitis. We report on 61 consecutive patients who presented with acute dysphagia and had endoscopic evaluation for a suspected esophageal foreign body. Foreign bodies were classified as food impactions (FI) and non-food impactions (NFI). Proximal location of obstruction was defined as the cricopharyngeus or above. Endoscopic findings consistent with esophagitis included erythema, friable or boggy mucosa, exudates, ulcerations, ringed appearance and furrowing of the mucosa. Histological findings consistent with EE included >20 eosinophils/high power field (HPF) on microscopy. There were 11 patients with FI and 48 with NFI. The mean age (yrs) for FI was 11.8 ± 2.3 and 4.6 ± 3.5 for NFI (p<0.05). In the FI group there were 100% male versus 63% male for NFI (p < 0.05). Proximal location of obstruction was 0% in FI and 58% in NFI (p < 0.05). Gross esophagitis was seen in 82% in FI and 8% in NFI (p < 0.05). Biopsy revealed 89% of FI versus 29% of NFI (p<0.05) had evidence for >20 eosinophils/HPF. In this case series of patients with acute dysphagia, the current findings emphasize the need to exclude EE in older males presenting with food impaction. Children with food impaction are more likely to have gross evidence for eosinophilic disease and should also be evaluated by biopsy. The possibility of EE existing in patients with other types of esophageal foreign bodies should also be considered and long-term longitudinal studies need to be performed to clarify the importance of these findings.