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Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis

Runge, Thomas M. MD, MPH*; Eluri, Swathi MD*; Cotton, Cary C. MD, MPH*; Burk, Caitlin M. BA*; Woosley, John T. MD, PhD; Shaheen, Nicholas J. MD, MPH*,‡; Dellon, Evan S. MD, MPH*,‡

Journal of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p 805–813
doi: 10.1097/MCG.0000000000000718
ALIMENTARY TRACT: Original Articles

Goals: To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation.

Background: Esophageal perforation is a serious complication of EoE.

Materials and Methods: We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation.

Results: Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair.

Conclusions: Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.

*Department of Medicine

Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology

Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC

This research was supported, in part, by NIH awards T32DK007634 (T.M.R.), T35DK007386 (C.M.B.), K24DK100548 (N.J.S.), K23DK090073 (E.S.D.), and R01DK101856 (E.S.D.).

The authors declare that they have nothing to disclose.

Address correspondence to: Evan S. Dellon, MD, MPH, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., UNC-CH, Chapel Hill, NC 27599-7080 (e-mail: edellon@med.unc.edu).

Received March 30, 2016

Accepted August 24, 2016

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