Elsevier

Gastrointestinal Endoscopy

Volume 53, Issue 2, February 2001, Pages 193-198
Gastrointestinal Endoscopy

Original Articles
Esophageal food impaction: Epidemiology and therapy. A retrospective, observational study

https://doi.org/10.1067/mge.2001.112709Get rights and content

Abstract

Background: Esophageal food impaction is common, but incidence data are lacking and management is controversial. This is a survey of its epidemiology, endoscopic findings, and treatment. Methods: A retrospective study was conducted of 194 adults with 223 episodes of esophageal food impaction in a health maintenance organization. Of these, 192 (99%) patients were followed a median of 31 months (range 1-72) post-disimpaction. Results: The estimated annual incidence rate of episodes was 13.0 per 100,000, and the male:female ratio was 1.7:1. The rate increased with age, especially after the seventh decade. The bolus was meat in 189 (85%) episodes. Flexible esophagoscopy was performed initially in 222 (99.6%) episodes and permitted disimpaction in 218 (98%). The push technique was used alone or in combination with extraction in 186 (84%). Immediate dilation was performed in 172 (79%). There were no major complications. A final diagnosis was made in 171 (88%), including 151 (78%) with a Schatzki's ring or peptic stricture, and the diagnosis had changed during follow-up in 14 (7%). A diagnosis of Schatzki's ring was associated with gender (p = 0.03) and decreased with increasing age (p = 0.003), especially among women. Conclusions: Esophageal food impaction is common and can nearly always be treated safely with flexible esophagoscopy, usually with the push technique. (Gastrointest Endosc 2001;53:193-8.)

Section snippets

Patients and methods

The members of the San Diego service area of the Kaiser Permanente Medical Care Program of Southern California, a group-model HMO, currently with over 500,000 members, were surveyed. Institutional Review Board approval was obtained. The age, gender, racial/ethnic distribution, and formal education of the members are known, and these characteristics resemble the census data on the residents of the San Diego region.9 Patients with esophageal food impaction between 1993 and 1998 were identified

Results

There were 223 episodes of esophageal food impaction among 194 patients (126 men and 68 women). The estimated annual incidence rate was 13.0 episodes per 100,000. Because the data from patients with multiple episodes were not independent, only data from the first episode were used in the patient analysis. Therefore the estimated annual incidence rate of patients with at least 1 impaction was 11.3 per 100,000 (15.5 in men and 7.5 in women). The median age of men was 59 years (range 23-93) and

Discussion

This study of HMO members found 13.0 episodes per 100,000 of esophageal food impaction requiring endoscopic treatment from 1993 through 1998. The rate in men was twice the rate in women and was nondecreasing with age, especially increasing after the seventh decade of life. Because hospitalization rates in the same HMO for acute upper GI hemorrhage9 and acute lower GI hemorrhage11 were estimated to be 102.0 and 22.0 per 100,000, respectively, this disorder seems to be the third most common

Acknowledgements

We are grateful to Drs. Daniel Anderson, Richard Brower, Steven Feitelberg, Robert Oakley, Matthew Sitzer, and Ulrika Schumacher for managing patients and Dr. Girma Wolde-Tsadik for statistical consultation.

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    Reprint requests: George F. Longstreth, MD, Kaiser Permanente Medical Center, 4647 Zion Avenue, San Diego, CA 92120.

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