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Sa2040 Food Impaction in Pediatric Patients With Eosinophilic Esophagitis
an esophageal stricture after previous surgery. Most children presenting with food bolus impaction therefore had underlying esophageal pathology. Conclusions: Food bolus impaction in children is nearly always a consequence of underlying esophageal disorder, of which EoE is the most common. We recommend that all children presenting with food bolus impaction have esophageal biopsies for EoE.
Sa2040 Food Impaction in Pediatric Patients With Eosinophilic Esophagitis Anne C. Mudde, Nicole Heinz, Madeleine Stout, Kitzia Colliard, Rina Wu, Edda Fiebiger, Samuel Nurko Introduction Eosinophilic esophagitis (EoE) is a chronic, inflammatory esophageal disease, characterized by eosinophilic inflammation and esophageal dysfunction. Upper gastrointestinal (GI) symptoms in EoE are age-dependent. Adults and adolescents typically experience dysphagia and food impaction, while the occurrence of food impaction in younger children is less common and poorly investigated. There is limited information regarding the natural history of food impaction in adolescents. Objective The aim of this research is to characterize a cohort of pediatric EoE patients who experienced food impaction, and describe their management of food impaction. Methods Retrospective cohort study of pediatric EoE patients who experienced food impaction. EoE patients aged 18 years or under, were included when their medical record described at least one incidence of true esophageal food impaction. Patients with EoE that also had a diagnosis of achalasia, esophageal atresia, or tracheoesophageal fistula were excluded. Results 32 children with EoE that experienced food impaction were identified . 91% were male. Average age at diagnosis of EoE was 13.9 +/- 3.0 years (age range 6.7-17.8 years). Average BMI at diagnosis of EoE was 21.4 (+/- 4.2) km/ m2. In all children food impaction was the initial presenting symptom. In 81% the impacted food was meat. Onset of upper GI symptoms was reported in 17 patients and varied between 0 months and 5 ½ years previous to the occurrence of food impaction. 28 children underwent allergy testing, 23 of which tested positive for food and/or environmental allergens. In 7 patients the impaction resolved before presenting to the ER. Figure 1 gives an overview of the medical treatment provided in the ER to 25 patients that presented with food impaction. No patient had esophageal strictures. Conclusions Food impaction resolved spontaneously in 40% of the children visiting the ER. This finding might have implications for the clinical management of food impaction in an emergency setting.
*Gr I Abnormal : 3 stricture, 1 small caliber esophagus, 1 spasm, 1 esophageal reflux. Gr II Abnormal: 1 stricture, 1 spasm, 2 esophageal reflux, 2 abnormal swallowing, 3 mucosal irregularity, 1 esophageal tear. Table 2:EGD and Esophageal biopsy findings at Diagnosis
Sa2039 Food Bolus Impaction in Children Is Nearly Always From Eosinophilic Esophagitis Thomas C. Bradley, Geoffrey D. Withers, Looi C. Ee Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Incidence and prevalence of this condition is increasing. The presentation of EoE varies with age but dysphagia is common in adults and older children. We hypothesize that most children requiring endoscopic management of food bolus impaction will have EoE. Methods: Retrospective review of all patients presenting or referred with food bolus impaction to a tertiary paediatric hospital between 1st Nov 2011 and 31st Dec 2014 inclusive. ICD-10 codes for endoscopy and removal of foreign body (30478-00, 30478-10) were used to identify patients who required endoscopy. All patients with esophageal foreign bodies were reviewed but only those with food in the esophagus were included in the study. EoE was defined as the presence of ‡15 eosinophils/ high power field on biopsy in either proximal and/or distal esophagus. Results: 138 endoscopies were performed in 133 children. Esophageal foreign bodies were noted in 78 procedures of which 76 were performed emergently. Procedures were mainly performed by gastroenterologists (n=50) and otolaryngologists (n=23). Common foreign bodies include coins (n=33), food (n=22), button battery (n=3), dental wire (n=3), and toys (n=3). 22 endoscopies were performed in 19 patients for food bolus impaction, and histology available in 14/19 (74%) patients. 79% (15/19) of these patients were male and median age at presentation was 12.08 (range 0.85-15.05) years. 79% (11/14) of those biopsied fulfilled histologic criteria for EoE. Interestingly the remaining 3 patients who had biopsies all demonstrated esophageal eosinophilia although their count (range 3-13eos/hpf) was insufficient to be diagnostic of EoE. 2/5 patients who did not have biopsies were known to have
Sa2041 Transpyloric Feeding in Gastroesophageal Reflux Associated Apnea of Preterm Neonates: Interim Results From a Single Center, Single Arm Trial Tamoghna Biswas, Somosri Ray, Tapas K. Sabui, Rakesh Mondal, Jiban Krishna De, Sudipta Misra Background: Retrospective studies have suggested a causal relationship between apnea and gastroesophageal reflux, though it remains controversial as both are common in premature neonates. We prospectively evaluated the efficacy and safety of transpyloric continuous feeding in preterm neonates with apnea suspected to be due to reflux; as such feeding reduces gastroesophageal reflux. . Methods: A single center, single arm, open label prospective interventional study was conducted in a tertiary care hospital of Eastern India. The study was approved by the Institutional Ethics committee of the Medical College Kolkata. Intramural preterm neonates with at least one episode of apnea without any comorbidities known to cause apnea and clinical features of gastroesophageal reflux, such as, regurgitation, backarching, choking, coughing, unexplained crying and irritability, post-prandial vomiting, etc. ; were included in the study. Non weighed feeding tube was placed transpyloriclly as described elsewhere. Continuous naso-duodenal tube feeding was administered for 72 hours. Exclusion criteria were, neonates not on enteral feeding, those on invasive mechanical ventilation, those with major congenital abnormalities, and those with conditions like sepsis, neurodeficits, hypoglycaemia etc. that can cause apnea. Primary outcome measure was the
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61(64%) had a follow up EGD, at 8-12 weeks and peak eos. count was 33.9 (SD35.5) and 30.5 (SD 27.5) and mean was 25.8 and 21.6 respectively (p=0.59). Patients with strictures (4); it stayed open after dilation while the small caliber esophagus was recalcitrant. 5/40 (12.5%) patients in Gr I had recurrence of FI and none in Gr II developed FI. Conclusion: There were no significant differences in the clinical features and endoscopic findings and outcome of dysphagia of the two groups. The peak eosinophil count was higher in the FI group, at presentation and follow up, suggesting more inflammation in this group. 12.5% of FI group patients had recurrence of FI. Strictures opened up and remained open, while small caliber esophagus was recalcitrant. The EoE-D, food impaction group, with its increased inflammation and recurrence risk may require more aggressive therapy. Less inflammation (Gr II) reduces risk of FI. More prospective studies with long term follow up are needed to validate this data. 1Gunasekaran T, Characterization of Dysphagia Associated EoE in Children with and without FI. DDW May 2015 Table 1:Presenting Symptoms and Esophagram
Sa2040 Food Impaction in Pediatric Patients With Eosinophilic Esophagitis Anne C. Mudde, Nicole Heinz, Madeleine Stout, Kitzia Colliard, Rina Wu, Edda Fiebiger, Samuel Nurko Introduction Eosinophilic esophagitis (EoE) is a chronic, inflammatory esophageal disease, characterized by eosinophilic inflammation and esophageal dysfunction. Upper gastrointestinal (GI) symptoms in EoE are age-dependent. Adults and adolescents typically experience dysphagia and food impaction, while the occurrence of food impaction in younger children is less common and poorly investigated. There is limited information regarding the natural history of food impaction in adolescents. Objective The aim of this research is to characterize a cohort of pediatric EoE patients who experienced food impaction, and describe their management of food impaction. Methods Retrospective cohort study of pediatric EoE patients who experienced food impaction. EoE patients aged 18 years or under, were included when their medical record described at least one incidence of true esophageal food impaction. Patients with EoE that also had a diagnosis of achalasia, esophageal atresia, or tracheoesophageal fistula were excluded. Results 32 children with EoE that experienced food impaction were identified . 91% were male. Average age at diagnosis of EoE was 13.9 +/- 3.0 years (age range 6.7-17.8 years). Average BMI at diagnosis of EoE was 21.4 (+/- 4.2) km/ m2. In all children food impaction was the initial presenting symptom. In 81% the impacted food was meat. Onset of upper GI symptoms was reported in 17 patients and varied between 0 months and 5 ½ years previous to the occurrence of food impaction. 28 children underwent allergy testing, 23 of which tested positive for food and/or environmental allergens. In 7 patients the impaction resolved before presenting to the ER. Figure 1 gives an overview of the medical treatment provided in the ER to 25 patients that presented with food impaction. No patient had esophageal strictures. Conclusions Food impaction resolved spontaneously in 40% of the children visiting the ER. This finding might have implications for the clinical management of food impaction in an emergency setting.
*Gr I Abnormal : 3 stricture, 1 small caliber esophagus, 1 spasm, 1 esophageal reflux. Gr II Abnormal: 1 stricture, 1 spasm, 2 esophageal reflux, 2 abnormal swallowing, 3 mucosal irregularity, 1 esophageal tear. Table 2:EGD and Esophageal biopsy findings at Diagnosis
Sa2039 Food Bolus Impaction in Children Is Nearly Always From Eosinophilic Esophagitis Thomas C. Bradley, Geoffrey D. Withers, Looi C. Ee Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Incidence and prevalence of this condition is increasing. The presentation of EoE varies with age but dysphagia is common in adults and older children. We hypothesize that most children requiring endoscopic management of food bolus impaction will have EoE. Methods: Retrospective review of all patients presenting or referred with food bolus impaction to a tertiary paediatric hospital between 1st Nov 2011 and 31st Dec 2014 inclusive. ICD-10 codes for endoscopy and removal of foreign body (30478-00, 30478-10) were used to identify patients who required endoscopy. All patients with esophageal foreign bodies were reviewed but only those with food in the esophagus were included in the study. EoE was defined as the presence of ‡15 eosinophils/ high power field on biopsy in either proximal and/or distal esophagus. Results: 138 endoscopies were performed in 133 children. Esophageal foreign bodies were noted in 78 procedures of which 76 were performed emergently. Procedures were mainly performed by gastroenterologists (n=50) and otolaryngologists (n=23). Common foreign bodies include coins (n=33), food (n=22), button battery (n=3), dental wire (n=3), and toys (n=3). 22 endoscopies were performed in 19 patients for food bolus impaction, and histology available in 14/19 (74%) patients. 79% (15/19) of these patients were male and median age at presentation was 12.08 (range 0.85-15.05) years. 79% (11/14) of those biopsied fulfilled histologic criteria for EoE. Interestingly the remaining 3 patients who had biopsies all demonstrated esophageal eosinophilia although their count (range 3-13eos/hpf) was insufficient to be diagnostic of EoE. 2/5 patients who did not have biopsies were known to have
Sa2041 Transpyloric Feeding in Gastroesophageal Reflux Associated Apnea of Preterm Neonates: Interim Results From a Single Center, Single Arm Trial Tamoghna Biswas, Somosri Ray, Tapas K. Sabui, Rakesh Mondal, Jiban Krishna De, Sudipta Misra Background: Retrospective studies have suggested a causal relationship between apnea and gastroesophageal reflux, though it remains controversial as both are common in premature neonates. We prospectively evaluated the efficacy and safety of transpyloric continuous feeding in preterm neonates with apnea suspected to be due to reflux; as such feeding reduces gastroesophageal reflux. . Methods: A single center, single arm, open label prospective interventional study was conducted in a tertiary care hospital of Eastern India. The study was approved by the Institutional Ethics committee of the Medical College Kolkata. Intramural preterm neonates with at least one episode of apnea without any comorbidities known to cause apnea and clinical features of gastroesophageal reflux, such as, regurgitation, backarching, choking, coughing, unexplained crying and irritability, post-prandial vomiting, etc. ; were included in the study. Non weighed feeding tube was placed transpyloriclly as described elsewhere. Continuous naso-duodenal tube feeding was administered for 72 hours. Exclusion criteria were, neonates not on enteral feeding, those on invasive mechanical ventilation, those with major congenital abnormalities, and those with conditions like sepsis, neurodeficits, hypoglycaemia etc. that can cause apnea. Primary outcome measure was the
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AGA Abstracts
AGA Abstracts
61(64%) had a follow up EGD, at 8-12 weeks and peak eos. count was 33.9 (SD35.5) and 30.5 (SD 27.5) and mean was 25.8 and 21.6 respectively (p=0.59). Patients with strictures (4); it stayed open after dilation while the small caliber esophagus was recalcitrant. 5/40 (12.5%) patients in Gr I had recurrence of FI and none in Gr II developed FI. Conclusion: There were no significant differences in the clinical features and endoscopic findings and outcome of dysphagia of the two groups. The peak eosinophil count was higher in the FI group, at presentation and follow up, suggesting more inflammation in this group. 12.5% of FI group patients had recurrence of FI. Strictures opened up and remained open, while small caliber esophagus was recalcitrant. The EoE-D, food impaction group, with its increased inflammation and recurrence risk may require more aggressive therapy. Less inflammation (Gr II) reduces risk of FI. More prospective studies with long term follow up are needed to validate this data. 1Gunasekaran T, Characterization of Dysphagia Associated EoE in Children with and without FI. DDW May 2015 Table 1:Presenting Symptoms and Esophagram