Wide discrepancy between best practice recommendations and real-life management of suspected eosinophilic esophagitis-associated food bolus impaction

Esophageal food impaction (EFI) is the leading complication in patients with undiagnosed eosinophilic esophagitis (EoE). Limited data exists on pre-hospital care, in-hospital management, and post-hospital follow-up in suspected EoE-associated EFI. This study aims to assess deviations between real-life management and guideline-based recommendations in suspected EoE-associated EFI. This retrospective multicenter study analyzed data from four major Swiss gastroenterology units on patients with EoE-associated EFI. Patients with GERD-related strictures or esophageal cancer were excluded. Data on demographics, emergency department (ED), endoscopy management, and follow-up were obtained from electronic health records. Associations between clinical factors and odds of biopsy were analyzed using logistic regression. Between January 2015 and December 2020, 198 EFI cases (median age 51 years, 29.8% female, 28% with previous EFI) were recorded. Patient delay-the time between symptom onset and ED admission-was ~ 270 minutes. Nearly all patients (94%) required endoscopic bolus removal. The median time from ED presentation to endoscopy was ~150 minutes. Esophageal biopsies were taken in just over half of the individuals (n = 97, 52%), leading to a new EoE diagnosis in 71 (68.9% of those biopsied). Biopsy odds decreased significantly with older age (OR 0.96; 95% CI 0.94-0.98, P < 0.05) and known EoE (OR 0.26; 95% 0.09-0.69, P < 0.05). Although EoE is a leading cause of EFI, too few patients with a high baseline probability of EoE undergo biopsy in the emergency setting. Among those biopsied, the majority received a new EoE diagnosis, highlighting the importance of histological assessment.