Document Detail

Food bolus impaction secondary to reflux strictures: a rural surgical experience.
MedLine Citation:
PMID:  18954788     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Benign esophageal strictures at the gastroesophageal (GE) junction secondary to acid reflux have an unknown altered natural history after dilation. STUDY DESIGN: We carried out a 7-year retrospective investigation from 2001 to 2007. RESULTS: Sixty-four patients presented with food bolus impaction at the GE junction. Reflux strictures were the cause in 42 (66%), neuromuscular disease or dysmotility in 2 (3%), esophageal cancer in 1 (2%), and no underlying pathology could be identified in 19 (29%). Duration of dilation-induced relief from impaction recurrence decreased with each subsequent dilation: first 30 +/- 21 months, second 27 +/- 15 months, and third 8 +/- 6 months. Patients taking proton pump inhibitors (PPIs) had a longer interval between dilations (25 +/- 9 months) compared with those who were not (20 +/- 12 months, p = 0.06). PPIs also decreased the number of subsequent dilations needed during the course of the study (1 +/- 1 versus 2 +/- 1 dilations, p = 0.02). Reflux strictures were more likely to cause another episode of impaction than no underlying pathology (relative risk, 2.7; 95% CI, 1.8-4.1; p < 0.0001). Mean followup was 38 months (range 2 to 120 months). CONCLUSIONS: Reflux strictures are well treated with dilation and PPIs. Although food bolus impaction can occur without an underlying pathology, patients with relux strictures are likely to have a recurrence and should be treated aggressively. Addition of PPIs appears to decrease the number of dilations that a patient will require and lengthen the interval between dilations. Patients requiring more than two dilations after initiation of PPI therapy are unlikely to have durable relief.
John Alfred Carr; James A Drennan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  207     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-28     Completed Date:  2008-11-18     Revised Date:  2009-05-21    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  745-50     Citation Subset:  AIM; IM    
Passavant Surgical Associates, Jacksonville, IL 62650, USA.
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MeSH Terms
Aged, 80 and over
Cohort Studies
Emergency Service, Hospital*
Esophageal Stenosis / diagnosis,  etiology,  surgery*
Esophagogastric Junction*
Gastroesophageal Reflux / complications*,  pathology,  therapy
Middle Aged
Retrospective Studies
Rural Health Services*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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