Division of Pediatric Gastroenterology, Hepatology and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Doctor's Office Tower, Suite 10226, 2200 Children's Way, Nashville, TN, 37232, USA.
Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
Dig Dis Sci. 2018 Jun;63(6):1428-1437. doi: 10.1007/s10620-018-4972-0. Epub 2018 Feb 20.
Esophageal food impaction (EFI) is a gastrointestinal emergency requiring immediate evaluation in the emergency room (ER) and an esophagogastroduodenoscopy (EGD) for disimpaction. EFI is also a distinct presenting feature of eosinophilic esophagitis (EoE). This study aimed at understanding the management of EFI among gastroenterologists (GIs) and estimated its impact on identification of EoE in USA.
GIs associated with three major gastroenterology societies based in USA were invited to participate in a web-based survey. Information on the resources available and utilized, and the clinical decision-making process related to management of EFI cases was collected and analyzed.
Of 428 responses, 49% were from pediatric GIs, 86% practiced in the USA, and 78% practiced in an academic setting. Compared to the pediatric GIs, adult GIs were more likely to perform EGD in the emergency room [OR 87.96 (25.43-304.16)] and advance the food bolus into stomach [5.58 (3.08-10.12)]. Only 34% of respondents obtained esophageal biopsies during EGD, and pediatric GIs were more likely to obtain esophageal biopsies [3.49 (1.12-10.84)] compared to adult GIs. In USA, by our conservative estimates, 10,494 patients presenting to ER with EFI and at risk of EoE are likely being missed each year.
EFI management varies substantially among GIs associated with three major gastroenterology societies in USA. Based on their practice patterns, the GIs in USA are likely to miss numerous EoE patients presenting to ER with EFI. Our findings highlight the need for developing and disseminating evidence-based EFI management practice guidelines.
食管食物嵌塞（EFI）是一种胃肠道急症，需要在急诊室（ER）进行紧急评估和食管胃十二指肠镜检查（EGD）以解除嵌塞。EFI 也是嗜酸性食管炎（EoE）的一个明显特征。本研究旨在了解美国胃肠病学家（GIs）对 EFI 的管理，并估计其对 EoE 识别的影响。
邀请与美国三大胃肠病学会有关的 GIs 参加基于网络的调查。收集和分析了有关管理 EFI 病例的可用资源和利用情况以及临床决策过程的信息。
在 428 份回复中，49%来自儿科 GIs，86%在美国执业，78%在学术环境中执业。与儿科 GIs 相比，成人 GIs 更有可能在急诊室进行 EGD[OR 87.96（25.43-304.16）]并将食物团推进胃中[5.58（3.08-10.12）]。只有 34%的受访者在 EGD 期间获得食管活检，儿科 GIs 比成人 GIs 更有可能获得食管活检[3.49（1.12-10.84）]。根据我们的保守估计，在美国，每年有 10494 名因 EFI 就诊 ER 且有患 EoE 风险的患者可能会被遗漏。
与美国三大胃肠病学会有关的 GIs 对 EFI 的管理方法存在很大差异。根据他们的实践模式，美国的 GIs 可能会错过许多因 EFI 就诊 ER 的 EoE 患者。我们的研究结果强调了制定和传播基于证据的 EFI 管理实践指南的必要性。
