Management of eosinophilic esophagitis associated food impaction in Europe and the United States

Philipp Schreiner*, Ekaterina Safroneeva, Alain Schoepfer, Thomas Greuter, Luc Biedermann, Christoph Schlag, Joachim Labenz, Marcus K.H. Auth, Albert J. Bredenoord, Joy W. Chang, Peter A. Bonis, Marc E. Rothenberg, Margaret H. Collins, Ikuo Hirano, Sandeep K. Gupta, David A. Katzka, Evan S. Dellon, Alex Straumann, Glenn T. Furuta, Nirmala Gonsalves

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Eosinophilic esophagitis (EoE) is the most common cause of esophageal food impaction (EFI). Approaches to management of EFI due to EoE have not been well characterized. We conducted a web-based survey to understand approaches to management of EFI due to EoE among endoscopists. Questions focused on management of patients from presentation to post-endoscopy follow-up. The survey was administered to a list of eligible candidates provided by societies of gastroenterology. A total of 308 endoscopists completed the questionnaire. The majority (83%) practiced in Europe and treated adults (78%). Most agreed patients should be advised to seek emergency care (66%) within 1 to 2 hours (41% agreement). There was agreement that medications to induce vomiting should be avoided (84%) and that blood tests or imaging studies were usually not required before endoscopy. By contrast, there was more variability in the type of sedation recommended and the need for endotracheal intubation, especially when comparing more experienced with less experienced EoE-endoscopists. Overall, fewer than half (43%) respondents recommended obtaining esophageal biopsies during the initial endoscopy. However, there were significant differences in the proportion who recommended biopsies based on level of EoE-experience (25, 52, 77%, P < 0.001; less vs. moderate vs. very experienced) and comparing pediatric and adult endoscopists (32, vs. 79%, P < 0.001; adult vs. pediatric). There exists heterogeneity among endoscopists in recommendations to manage EFI in patients with EoE. These findings support development of clinical guidelines and new studies to clarify the rationale for best practices. Key summary: Established knowledge - The optimal management of patients with esophageal food impaction due to eosinophilic esophagitis from presentation at the emergency department to postendoscopy care is unclear. New findings - Considerable recommendation variation exists in the management of EFI in patients with EoE. Our findings provide a rationale for the creation of consensus practice guidelines and further study into best practices.

Original languageEnglish (US)
Article numberdoac003
JournalDiseases of the Esophagus
Volume35
Issue number9
DOIs
StatePublished - Sep 1 2022

Keywords

  • eosinophilic esophagitis
  • esophageal food impaction
  • esophagus

ASJC Scopus subject areas

  • General Medicine

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