Esophageal biopsy advised in children with foreign body impaction

By Ingrid Grasmo

Study findings suggest that a considerable number of children with esophageal foreign body (FB) or food bolus impaction have eosinophilic esophagitis (EoE).

"Endoscopists do not usually take esophageal biopsies if the esophagus looks normal during endoscopic FB extraction. Consequently, it is difficult to know how many patients with a normal-looking esophagus would have EoE, although it is an increasingly recognized condition in both children and adults," say Wael El-Matary (Children's Hospital, Manitoba, Canada) and colleagues.

To examine the feasibility of esophageal biopsies for diagnosis of EoE, the researchers investigated the prevalence of EoE among 140 children aged on average 5 years with esophageal FB impaction who required endoscopic removal.

Of the children included in the study, 115 had symptoms relating to FB impaction including chest discomfort, respiratory distress, drooling, vomiting, odynophagia, and dysphagia. Coins were the most common FB, found in 78% of children, followed by impacted food, in 13%.

Overall, 11 children (7.9%) were diagnosed with EoE and biopsies were performed in 20 patients due to evidence of abnormal esophageal morphology.

Further analysis showed that seven (39%) of the 18 children with food impaction were diagnosed with EoE, while four (3%) of the 122 children with esophageal FBs other than food had with EoE. Three of these four children had no symptoms of EoE before the accidental FB ingestion.

Conversely, five of the seven children with food bolus impaction and EoE had a history of dysphagia or gastroesophageal reflux disease prior to presentation to hospital with food bolus impaction.

The researchers say the findings show that 55% of the 20 children with esophageal FB or food bolus impaction with an abnormal esophagus and biopsies were diagnosed with EoE. The remainder did not have EoE.

Given that the majority of patients did not undergo a biopsy, El-Matary and team caution that the true prevalence of EoE may have been underestimated.

"It is reasonable to consider taking esophageal biopsies routinely in all patients with food bolus impaction, even in those patients with normal looking esophagus… symptoms of EoE can be subtle, some children are too young to express their symptoms and esophageal mucosa may look normal in many patients with EoE," conclude the researchers in Pediatric Emergency Care.

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