S1045 Esophageal Food Impactions over the Last Decade: Epidemiology, Outcomes, and the Association With Eosinophilic Esophagitis

Introduction: Esophageal food impaction (FI) is a gastrointestinal emergency with severe complications including esophageal ulcers, necrosis, or perforation. Historically, the most common etiology of food impaction is peptic stricture due to gastroesophageal reflux disease. With the increased use of proton pump inhibitors, the prevalence of peptic strictures is declining. In contrast, the prevalence of eosinophilic esophagitis (EoE) is increasing. There is limited data on the epidemiology of FI in recent years. We evaluated the etiology of food impactions and clinical outcomes over the last decade. Methods: This is a retrospective, single-center study of patients with esophageal FI confirmed on esophagogastroduodenoscopy (EGD) from 2012 to 2022. Patients were separated into 2 groups by year of food impaction (2012-2017 and 2018-2022). Clinical, endoscopic, and histologic data was identified through manual chart review. Differences in distributions of patient characteristics between time periods were evaluated using t-test, Kruskal Wallis test, Chi-square test or Fisher’s exact test, as appropriate. Logistic regression estimated the odds ratio (OR) and 95% confidence interval (CI) for the effect of EoE on subsequent FI. Results: Of 104 patients, 53 had a FI between 2012-2017 and 51 between 2018-2022, 64% were men, mean age (standard deviation) was 61.6 (17.9) and 72% were White. Etiology of FI was similar between time periods. Esophageal stenosis was the most common cause of FI, 30% of patients from 2012-2017 and 41% of patients from 2018-2022. EoE was the second most common cause FI and the primary etiology in 18.9% of patients between 2012-2017 and 15.7% between 2018-2022. Fifty-nine (55%) of the 104 patients had esophageal biopsies, 17 (28.8%) had EoE. Eighteen patients had subsequent FI during the study period with similar rates between time periods (17.0% vs 17.6% for 2012-2017 vs 2018-2022, respectively, P = 0.929). EoE patients had a non-statistically significant lower odds of recurrent food impaction compared with other etiologies (OR, 95% CI 0.547 (0.11, 2.62); P = 0.450). Conclusion: Esophageal stenosis was the most common cause of FI, followed by EoE, but there was no significant difference in frequency between the 2 groups by time. Only 55% of patients had esophageal biopsies, so it is likely there were missed diagnoses of EoE. Obtaining esophageal biopsies in patients with FI is essential to evaluate for EoE and other etiologies because timely diagnosis and treatment improves patient outcomes, such as recurrent FI.