Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients

Clin Gastroenterol Hepatol. 2008 May;6(5):598-600. doi: 10.1016/j.cgh.2008.02.003. Epub 2008 Apr 14.


Background & aims: Eosinophilic esophagitis is a rapidly emerging, chronic inflammatory disorder. Prolonged inflammation evokes structural alterations and a fragile esophageal wall prone to perforation/rupture and food impaction. This report assesses the risk of spontaneously arising and procedure-induced complications and proposes practical recommendations.

Methods: The Swiss Esophageal Esophagitis Database documented 251 confirmed cases. A chart review identified which patients had required endoscopic bolus removal and/or experienced transmural esophageal perforation/rupture. In addition, a MEDLINE search for "eosinophilic esophagitis" with "esophageal perforation" or "esophageal rupture" was undertaken.

Results: During an 18-year period, 87 patients (34.7%) experienced 134 food impactions requiring flexible (124, 92.5%) or rigid (10, 7.5%) endoscopic bolus removal. Transmural perforation occurred in 20% (2/10) of rigid procedures, and 1 esophageal rupture (Boerhaave's syndrome) was observed.

Conclusions: Bolus removal by rigid endoscopy is a high-risk procedure and should be avoided in eosinophilic esophagitis patients who require a gentler approach. Whether food impaction and esophageal wall remodeling can be prevented with anti-inflammatory medication is still undetermined. All Boerhaave's syndrome cases should be evaluated for underlying eosinophilic esophagitis.

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Deglutition Disorders / etiology*
  • Deglutition Disorders / therapy
  • Eosinophilia / complications*
  • Eosinophilia / diagnosis
  • Esophageal Perforation / epidemiology
  • Esophageal Perforation / etiology*
  • Esophageal Stenosis / epidemiology
  • Esophageal Stenosis / etiology*
  • Esophagitis / complications*
  • Esophagitis / diagnosis
  • Esophagoscopy / adverse effects*
  • Female
  • Follow-Up Studies
  • Food
  • Humans
  • Male
  • Registries
  • Risk Assessment
  • Severity of Illness Index
  • Switzerland
  • Treatment Outcome