Objectives: To determine the clinical presentation, radiographic, endoscopic and manometric findings, and clinical outcome of esophageal food impaction (EFI) in pediatric patients.
Methods: We retrospectively reviewed the clinical course of 12 pediatric patients with EFI over a 10-year period.
Results: All 12 patients described initially presented to our emergency department for care. Four patients (25%) required previous endoscopic intervention for disimpaction of EFI. Eleven required endoscopic removal of their EFI, and 1 patient's food impaction resolved spontaneously. The mean duration of food impaction was 20 hours prior to endoscopic intervention. Endoscopy demonstrated an esophageal stricture in 1 patient with a history of trisomy 21 and tracheoesophageal fistula repair. While there was no visual evidence of esophagitis in any patient, 5 of 7 had histologic evidence of esophagitis. Upper gastrointestinal series demonstrated the esophagus to be anatomically normal in 10 of 12 patients (83%); 1 patient had an esophageal stricture and another an esophageal web. Four of 8 patients studied had nonspecific esophageal motility abnormalities.
Conclusions: EFI in children is not generally associated with underlying esophageal anatomic abnormalities. Esophagitis and nonspecific esophageal motility disorder abnormalities may be etiologic factors. Endoscopic removal of the EFI was safe and effective and is recommended as there is little likelihood of spontaneous resolution of EFI in children.
Esophageal food impaction (EFI) is said to be present when a bolus of food becomes lodged in the esophagus. This occurrence is usually recognized clinically as the abrupt onset of dysphagia related to food ingestion, preventing the subsequent passage of food and resulting in the need for emergency care. This problem occurs most frequently in older adults and is rarely seen in children. Most food impaction in adults occurs because underlying esophageal anatomic pathology. 1-4 To date, there has been little data published describing EFI in children. We therefore chose to perform a retrospective study of 12 children with EFI to better define this problem in the pediatric population.