A retrospective cohort study on oesophageal food bolus obstruction in the North Denmark region in 2021-two thirds were never diagnosed with a cause

Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possi...

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Published in:	BMC gastroenterology Vol. 24; no. 1; p. 3
Main Authors:	Terkelsen, Jacob Holmen, Hollænder, Martin, Bredal, Kasper, Nielsen, Sara Munk, Thomsen, Kristoffer Vittrup Koed, Baggerman, Amanda, Ofverlind, Emilia, Koc, Alptug Mertcan, Pakes, Hannah, Mahdi, Marco Bassam, Larsen, Sanne Ørnfeldt, Gonzalez, Vanessa Parra, Riis, Johannes, Frandsen, Line Tegtmeier, Melgaard, Dorte, Krarup, Anne Lund
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 02-01-2024 BioMed Central BMC
Subjects:	Aged Aged, 80 and over Analysis Biopsy Care and treatment Codes Cohort analysis Data analysis Denmark - epidemiology Diagnosis Emergency medical care Endoscopy Eosinophilic Esophagitis - complications Eosinophilic Esophagitis - diagnosis Eosinophilic Esophagitis - epidemiology Eosinophilic oesophagitis Esophageal cancer Esophageal Stenosis - diagnosis Esophageal Stenosis - epidemiology Esophageal Stenosis - etiology Esophagitis Food Food Bolus Impaction Food Bolus obstruction Foreign bodies Health aspects Hospitals Humans Leukocytes (eosinophilic) Malignancy Medical records Middle Aged Oesophageal cancer Oesophagus Pathology Patients Retrospective Studies Stenosis Upper Endoscopy Denmark Oesophageal cancer Eosinophilic oesophagitis Oesophagus Food Bolus obstruction Upper Endoscopy Food Bolus Impaction
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Summary:	Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. The median patient age was 66.0 (Q1-Q3: 49.8-81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-230X 1471-230X
DOI:	10.1186/s12876-023-03077-8