Observational Field Study of Acute Esophageal Food Bolus Impaction by Mean Esophageal Manometry and 24h-pH-monitoring

The key function of the esophagus ist (i) the immediate transport of the food bolus from the mouth to the stomach and (ii) to inhibit reflux from the stomach back to the esophagus.

Motility disorders of the esophagus lead to an impaired bolus transport and/or reflux of stomach content to the esophagus, and may cause symptoms such as (obstructive) dysphagia, chest pain, heart burn and/or regurgitation.

Acute esophageal food impaction is a common acute condition of the upper GI tract that usually needs immediate medical attention. The food bolus, e.g. a peace of red meat or similar is blocked within the tubular part of the esophagus, e.g. proximal to the esophagogastric junction and neither passes spontaneously into the stomach nor can be regurgitated actively. In this case it usually requires upper endoscopy for endoscopic removal of the food bolus.

Possible causes of food impaction are (i) structural obstruction within the esophagus such as a Schatzki's ring, an esophageal web, a peptic stenosis secondary to gastroesophageal reflux disease, or more rarely esophageal carcinoma [1, 2]; (ii) functional causes of obstruction are mainly Achalasia or Esophageal Esophagitis (EE). In Achalasia a idiopathic neurodegenerative destruction of the inhibitory neurons of the esophagus leads to a failure of the lower esophageal sphincter to relax and an impaired esophageal peristalsis. Patients usually present with a history of progressive dysphagia and regurgitation of undigested food, but rarely a food impaction can occur [3]. Eosinophilic Esophagitis is a idiopathic disorder in which eosinophilic infiltration of the mucosal wall leads to an impaired esophageal motility, which usually causes dysphagia, retrosternal pain or food bolus impaction.[3] Its etiology remains unknown but several studies suggest an allergic response to food and allergens. Previously believed to be a rather rare disease and therefore rare cause for bolus impaction, eosinophilic esophagitis has emerged as one of the most common causes for food impaction and dysphagia in general [4]. The increase in prevalence is not entirely clear; besides better recognition by gastroenterologists and pathologists there seems to be a true increase in incidence, probably due to an increased incidence of allergic diseases [5]. Its diagnosis is difficult due to other causes of eosinophilic infiltrate such as gastroesophageal reflux disease or eosinophilic gastroenteritis[3].

The reason for an impaired motility in EE is unknown, although several hypothetic mechanisms are discussed [6]: (i) increased contraction of fibroblast secondary to presence of eosinophilic granulocytes, (ii) axonal necrosis secondary to eosinophilic degradation (iii) binding of eosinophil derived MBP (major basic protein) to muscarinic acetylcholine receptors leading to increased contraction.