Food bolus impaction, strictures may lead to oesophageal perforation
A recent study has found that food bolus impaction or strictures predict most episodes of oesophageal perforation, a rare but serious complication of eosinophilic esophagitis (EoE) that occurs in about 2 percent of cases. This suggests that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.
Researchers conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014 to characterize patients with perforation in the context of EoE and to identify predictors of perforation.
Included in the study were patients who had an incident diagnosis of EoE and met consensus guidelines, as well as nonresponse to a proton pump inhibitor trial. The investigators identified patients with EoE who had suffered perforation at any point during their course and compared them with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation.
A total of 511 patients with EoE were identified. Of these, 10 (2.0 percent) had an oesophageal perforation.
Patients with perforation tended to have a longer duration of symptoms before diagnosis (11.4 vs 7.0 years; p=0.13), but the only factors independently associated with perforation were a history of food impaction (odds ratio [OR], 14.9; 95 percent CI, 1.7 to 129.2) and the presence of a focal stricture (OR, 4.6; 1.1 to 19.7).
Eighty percent of perforations happened after a prolonged food bolus impaction, and only five of the patients (50 percent) presented with an EoE diagnosis at the time of perforation. None occurred after dilation. In addition, six patients (60 percent) received nonoperative management, and four (40 percent) required surgical repair.