Eosinophilic Esophagitis Is the Leading Cause of Food Bolus Impaction Requiring Endoscopy in Calgary, Canada
Bibliographic record
Abstract
Introduction: Eosinophilic esophagitis (EoE), a known cause of dysphagia, is increasingly associated with foreign body/food impaction (FBI), requiring urgent endoscopic removal in children and adults. This study examines the prevalence of EoE in patients requiring FB removal in Calgary and its surrounding areas. Methods: A retrospective review of all emergency (ER) and urgent care FB presentations from November 2015 to September 2016 in a population of approximately 1.2 million people was performed using the regional electronic health database. Patient's age, sex, clinical impression, endoscopy, and pathology was collected in agreement with local research ethics (ARECCI) guidelines. Results: A total of 334 patients presented with symptoms of FBI. 131 patients were excluded: 100 had FB that spontaneously resolved without a GI assessment and 31 had non-GI concerns (e.g. drug overdose, allergic reaction, psychosis, and seizures). The remaining 203 patients underwent gastroscopy (EGD). Their average age was 39 ± 14 years; the majority were male (M: F ratio was 133:70). EoE was identified in 35% of all EGDs; 65% had other esophageal disorders (Figure 1). For the 72 patients in whom EoE was endoscopically evident, 22% were known cases of EoE whereas 78% underwent subsequent confirmation with biopsies. Biopsies were not performed in those with an endoscopically normal esophagus or a Schatzki's ring (Figure 1). A minority of patients (35%) with EoE features had a biopsy at the initial endoscopy (Table 1). Of the EoE cases, 9 patients (4 previously known and 5 new cases) had experienced more than one episode of FBI. The most common management in ER was to prescribe PPIs and repeat an EGD as an outpatient (90%). Those with a prior history of FBI or EoE were more likely to be prescribed budesonide plus PPI. The remaining 10% were scheduled for follow-up only.Figure: Esophageal findings in documented food bolus impaction in 203 patients.Table: Table. Patient demographics and eosinophilic esophagitis related informationConclusion: EoE is the most common cause (35%) of FBI necessitating urgent endoscopic removal in Calgary. As mucosal biopsies were not taken from all patients with FBI, the true incidence of EoE is likely underestimated. Education and better follow-up are needed for the 12.5% (9/72) of patients that frequented ER for >1 episode of FBI. Given the rate of detection in ER, obtaining biopsies at the preliminary EGD for FBI should become a standard of practice for early detection and diagnosis of EoE.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".