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Predictors of Recurrent Esophageal Food Impaction

A Population-Based Case-Control Study

62

Prasad, Ganapathy A., M.D.; Reddy, Jagadeshwar G., M.D.; Enders, Felicity B., Ph.D.; Schmoll, Jeffrey A., B.S.; Wongkeesong, Louis-Michel, M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S43–S44
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN and Division of Biostatistics, Mayo Clinic, Rochester, MN.

Purpose: Esophageal food impaction (FI) is a distressing condition that requires urgent endoscopic intervention, with a recurrence rate of about 20%. Knowledge of factors predisposing to recurrent FI may enable the initiation of preventive measures that minimize the risk of recurrence. The aim of this exploratory study was to identify factors associated with recurrent FI.

Methods: Medical records of all patients undergoing emergent endoscopy for FI at Mayo Clinic Rochester (MCR) from 1989 to 2000 were reviewed. Cases and controls used MCR as their primary health care provider and resided within 50 miles of MCR. Cases were defined as presenting with recurrent FI requiring endoscopic intervention within 5 years of the index event; controls had no recurrent FI within 5 years of the index event. Several variables from patient demographics, medical history, endoscopic findings and therapy, and follow up data were extracted for analysis. Statistical significance was determined with X2 tests and t-tests for univariate analyses and stepwise logistic regression for multivariate analyses.

Results: 52 cases and 124 controls were identified. The most common causes of FI were Schatzki's ring (cases 39%; controls 32%) and peptic stricture (cases 31%; controls 33%) [p = NS]. Cases and controls were similar with respect to age, gender and BMI. Dentures were worn by 32% of cases and 39% of controls [p = NS]. GERD was present in 35% of cases and 23% of controls [p = NS]. Esophageal dilation was performed at the index FI in 37% cases and 38% controls [p = NS]. Results of multiple logistic regression analyses are shown in the table.

Table

Table

Conclusions: The presence of a DH, complexity of endoscopic disimpaction technique (piecemeal extraction) and lack of follow-up were associated with recurrent FI. The collection of esophageal biopsies as a positive variable suggests a visibly more severe esophageal disorder as a potential cause of recurrent FI. This study provides preliminary data for the development of a FI Severity Score and management algorithm to reduce the risk of recurrent FI.

© The American College of Gastroenterology 2005. All Rights Reserved.