Eosinophilic oesophagitis is a common cause of oesophageal food bolus obstruction but is often missed because of a low biopsy rate, an Australian study has found.

A retrospective review of medical records for 123 adults who underwent endoscopy after presenting to a NSW emergency department with oesophageal food bolus obstruction found that eosinophilic oesophagitis accounted for 18.7% of cases overall.

Eosinophilic oesophagitis (EoE) was particularly common in younger patients, being found in more than 80% of patients with food bolus obstruction under the age of 40, according to the study conducted by Dr Dane Cook and colleagues at the  Department of Gastroenterology and Endoscopy, John Hunter Hospital.

Other findings on investigation of food bolus obstruction included malignancy 4.%, motility disorder 12.2%, benign stricture/stenosis 16.3%, reflux oesophagitis 13% and ‘other/unknown’ 22.8%.

Writing in the Internal Medicine Journal the study authors said eosinophilic oesophagitis is now recognised as a major cause of dysphagia and FBO and the prevalence has been increasing since it was first recognised in the 1990s.

However they noted that histologic confirmation required  4 to 6 oesophageal biopsies taken from different sites, and therefore many cases would be missed if  biopsy rates are low.

In the current review, 46% of patients with food bolus obstruction were biopsied, of whom one in three patients (34%)  had at least 4 biopsies. Of those patients with findings of EoE who were biopsied, 48% had at least four biopsy samples taken.

The study authors said the 18% rate of eosinophilic oesophagitis observed in the current review was higher than the 13% rate seen  a previous review done in 2012–2014, but less than the 60% rate reported in another Australian centre.

“It is plausible that the higher proportion of EoE diagnoses is in part due to the higher biopsy rate,” they said.

The study investigators said their findings also showed that performing food bolus removal with procedural sedation was safe when compared to general anaesthesia.

“Complication rates (aspiration, bleeding, perforation, mucosal tears) were low in both those who had procedural sedation and those who had general anaesthesia, with no significant difference between the two groups with regards to all complications,” they noted.