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DOI: 10.1055/s-2006-924747
Georg Thieme Verlag KG Stuttgart, New York · Masson Editeur Paris
Non Stenotic Food Impaction Due to Eosinophilic Esophagitis: A Potential Surgical Emergency
Publication History
Received: May 1, 2006
Accepted after Revision: May 13, 2006
Publication Date:
08 January 2007 (online)
Abstract
Aim: Eosinophilic esophagitis (EoE) is an emergent condition in which a mucosal infiltrate of > 20 eosinophils per high power microscopic field is accompanied by motor disturbances that may cause food impaction in the absence of esophageal stricture. We report a series of such cases to point out the potential involvement of pediatric surgeons in diagnosis and treatment. Furthermore, data on the motor function of the esophagus investigated manometrically is included. Material and Methods: Thirteen patients with EoE were referred to our emergency room for acute food bolus impaction. Their median age at diagnosis was 12 years (range 7.6 - 14.4). History of allergy, endoscopy with biopsy and esophageal function (24-h combined ambulatory manometry with simultaneous pH-metry) were investigated. Results: In 7 patients emergency endoscopic extraction of the impacted bolus was necessary. Allergic tests were positive in eight patients. The pH probe showed gastroesophageal reflux in two cases. Upon endoscopy, typical features of EoE (esophageal trachealization and whitish papular exudates) were found. Ambulatory 24-h manometry revealed abnormal motility of the distal esophagus with strikingly high amplitudes (> 150 mmHg) and long duration (> 7 sec) of the waves, particulary during the night. Six patients responded rapidly to steroids and/or antiallergic treatment. The remaining patients had a good outcome with dietary treatment alone. Conclusions: EoE is an emergent condition that may involve the pediatric surgeon in both the diagnosis and treatment. Typical endoscopic findings and biopsy are required for proper diagnosis. Ambulatory manometry reveals a marked propulsive dysfunction that explains impaction. This dysfunction is reversible, since the symptoms usually disappear with steroids or antiallergic treatment.
Key words
Eosinophilic esophagitis - allergy - ambulatory - manometry - impaction - dysphagia
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Prof. Dr. Juan A. Tovar
Department of Pediatric Surgery
Hospital Universitario “La Paz”
Paseo de la Castellana, 261
28046 Madrid
Spain
Email: jatovar.hulp@salud.madrid.org