Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis

Thomas M. Runge, Swathi Eluri, Cary C. Cotton, Caitlin M. Burk, John T. Woosley, Nicholas J. Shaheen, Evan S. Dellon

Research output: Contribution to journalArticle

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Abstract

Goals: To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. Background: Esophageal perforation is a serious complication of EoE. Materials and Methods: We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation. Results: Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair. Conclusions: Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.

LanguageEnglish (US)
Pages805-813
Number of pages9
JournalJournal of Clinical Gastroenterology
Volume51
Issue number9
DOIs
StatePublished - Jan 1 2017

Fingerprint

Eosinophilic Esophagitis
Esophageal Perforation
Food
Pathologic Constriction
Odds Ratio
Confidence Intervals
Dilatation
Cohort Studies
Retrospective Studies
Logistic Models
Databases
Guidelines

Keywords

  • complication
  • endoscopy
  • eosinophilic esophagitis
  • food impaction
  • perforation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis. / Runge, Thomas M.; Eluri, Swathi; Cotton, Cary C.; Burk, Caitlin M.; Woosley, John T.; Shaheen, Nicholas J.; Dellon, Evan S.

In: Journal of Clinical Gastroenterology, Vol. 51, No. 9, 01.01.2017, p. 805-813.

Research output: Contribution to journalArticle

Runge, Thomas M. ; Eluri, Swathi ; Cotton, Cary C. ; Burk, Caitlin M. ; Woosley, John T. ; Shaheen, Nicholas J. ; Dellon, Evan S./ Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis. In: Journal of Clinical Gastroenterology. 2017 ; Vol. 51, No. 9. pp. 805-813
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abstract = "Goals: To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. Background: Esophageal perforation is a serious complication of EoE. Materials and Methods: We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation. Results: Out of 511 subjects with EoE, 10 (2.0{\%}) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95{\%} confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95{\%} confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80{\%}) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60{\%}) were treated with nonoperative management, and 4 (40{\%}) required surgical repair. Conclusions: Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2{\%} of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.",
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N2 - Goals: To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. Background: Esophageal perforation is a serious complication of EoE. Materials and Methods: We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation. Results: Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair. Conclusions: Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.

AB - Goals: To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. Background: Esophageal perforation is a serious complication of EoE. Materials and Methods: We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation. Results: Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair. Conclusions: Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.

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