Lincoln Olivio Diniz MPH, Presenter: Nothing to Disclose

Alex Towbin MD, Abstract Co-Author: Nothing to Disclose

Food bolus impaction with esophageal obstruction is a gastrointestinal emergency that may require immediate intervention. In children, the most common cause of food impaction is thought to be an esophageal stricture caused by prior esophageal atresia with tracheoesophageal fistula repair (EA-TEF) or eosinophilic esophagitis (EE).  In children with EE, infiltration of the esophagus with eosinophils leads to edema and inflammation with possible fibrosis over time. Eosinophilic infiltration in patients with EE can alter the structural integrity, luminal patency, and motility of the esophagus. Rapid ingestion of poorly chewed food in the setting of a small caliber esophagus or an esophageal stricture exceeds the capacity of the esophagus and results in food impaction. The purpose of our study was to evaluate the causes of food impaction in children.

A search of all dictated upper GI and esophagram reports between 1993 and March, 2009 was performed to looking for the phrases “impacted food,” “food impaction,” and “filling defect.” The reports were then reviewed to confirm the findings were present. If a true filling defect was present, the patient’s medical record was reviewed to identify the underlying cause of food impaction. All diagnoses of EE were confirmed by pathology reports.

There were 506 studies identified in 475 patients. A filling defect was present in 52 studies on 46 patients. In patients with a filling defect, 23 (50%) had biopsy-proven EE; 11 (24%) had a history of prior EA-TEF repair, and 4 (9%) had prior Nissen fundoplication. There were 3 patients who had both EE and EA-TEF. There were 9 patients without biopsy or an identifiable cause of food impaction.

EE is the most common cause of food impaction in children. Post-operative complications, such as esophageal stricture after EA-TEF repair or a tight Nissen fundoplication, account for most of the remaining cases of impacted food. At least half of the patients with food impaction in this study had biopsy-proven EE. The high percentage of food impaction in these children is likely explained by the structural and functional alterations that occur in the esophagus due to EE.

EE is the most common cause of food impaction in children and is the most likely diagnosis if there is no history of esophageal surgery.  

Diniz, L, Towbin, A, Causes of Food Impaction in Children.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8006326.html