Causes of Esophageal Food Bolus Impaction in the Pediatric Population

Esophageal food bolus impaction is an uncommon entity in the pediatric population that presents with the acute onset of dysphagia, pain, and vomiting. The causes of esophageal food bolus impaction are thought to be different in the pediatric population as compared to adults. The purpose of this study was to determine the frequency of the different causes of food impaction in patients who undergo an esophagram or upper GI examination. The radiology report database was searched to identify all patients with an esophageal food bolus impaction diagnosed on upper GI or esophagram between 1993 and 2009. Two pediatric radiologists then evaluated each esophagram to determine the location of the filling defect within the esophagus. Finally, the electronic medical record was queried to identify demographic information and abnormalities associated with the food impaction. After querying the radiology database, 43 patients were identified with an impacted food bolus on esophagram or upper GI. There were three abnormalities associated with food impaction: eosinophilic esophagitis (23/43; 53%), prior esophageal atresia repair (11/43; 26%), and prior Nissen fundoplication (5/43; 12%). There were eight patients in whom no underlying abnormality was identified. Eosinophilic esophagitis is the major abnormality associated with food bolus impaction in pediatric patients followed by narrowing at the site of prior esophageal or esophageal-related surgery.