Association of eosinophilic inflammation with esophageal food impaction in adults

Introduction: Esophageal food impaction is a common presentation of eosinophilic esophagitis. The prevalence of eosinophilic esophagitis among patients with food impaction is unknown. To address this, we evaluated clinicopathologic features of adults with food impaction. Methods: For a 3-year period, patients from a single, adult, community-based gastroenterology practice with esophageal food impaction were evaluated. Histories were assessed and esophageal biopsy specimens were evaluated by routine and immunohistochemical techniques. Results: Thirty-one patients with food impaction were evaluated. Seventeen of 31 patients had > 20 eosinophils/high power field (HPF) without gender predilection. Thirteen of these 17 patients had been treated with proton pump inhibitors at the time biopsy specimens were obtained. Patients with > 20 eosinophils/HPF were significantly younger (mean age 42 +/- 4 years) than patients with < 20 eosinophils/HPF (mean age 70 + 3 years). Superficial white exudates and eosinophilic microabscesses in the squamous epithelium were features observed only in patients with > 20 eosinophils/HPF. Immunopathologic analysis demonstrated increased CD8 lymphocytes and major basic protein deposition in their squamous epithelium. Conclusions: More than half of patients with esophageal food impaction in a primary gastroenterology practice have > 20 eosinophils/HPF. Based on clinicopathologic features, a significant number likely have eosinophilic esophagitis.