S998 Characteristics and Longitudinal Outcomes of Eosinophilic Esophagitis (EoE) Patients With Initial Food Impactions Following Discharge From Emergency Departments (ED)

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Introduction: Annual EoE-associated emergency department (ED) visits are expected to continue to rise, posing a significant healthcare burden. Few studies have evaluated the outcomes after the initial esophageal food impactions (EFI) and the presenting factors affecting EFI recurrence. We aim to evaluate the baseline characteristics and longitudinal outcomes of adult patients who present to the ED with EFI and diagnosed with biopsy-proven EoE. Methods: This is a retrospective study performed at a non-university health system aimed to characterize adult patients who presented to the ED from 2017 to 2024 for EFI due to EoE. Patients were categorized based on the presence or absence of gastroenterology (GI) follow-ups after the initial ED visit for EoE-related EFI. The primary outcome is the time from initial EFI to recurrence requiring ED visit. Patients with esophageal malignancy, history of palliative stenting, mediastinal radiation history, lymphocytic esophagitis, or those without histologically confirmed EoE were excluded. We performed a logistical regression analysis to identify associated risk factors. Results: Two hundred fifty-six patients had EFI due to EoE. Manual chart review identified 144 (67% men) who met inclusion criteria. The mean age at initial EFI was 49 ± 14 years. Twenty-eight (19%) had a recurrent EFI; 19 were men (68%). The mean time to EFI recurrence requiring ED revisit was 842 ± 147 days. The mean time from initial EFI to GI follow-up was longer in those with recurrent EFI: 769 ± 210 vs 186 ± 50 days (P = 0.015). In the recurrent EFI group, at baseline, these EoE patients had lower rates of atopy (29% vs 49%; P = 0.05), but higher rates of elevated body mass index (BMI) (25-29.9) (71% vs 47%; P = 0.0167), higher rates of current smokers (10% vs 1%; P = 0.0364), and higher rates of lower income ($50,000-$74,900) (25% vs 5%; P = 0.0293). Men with atopy had lesser odds of having recurrent EFI compared to men without atopy (odds ratio [OR] = 0.213; 95% confidence interval [CI] 0.047-0.705; P = 0.021). In patients with recurrent EFI, there was no difference between the use of proton pump inhibitor (PPI) or combination therapy with PPI and topical corticosteroid (OR = 0.942; 95% CI 0.374-2.606). Conclusion: Our study is consistent with prior studies showing that a delay in EoE care results in EoE-related complications, including EFI. We identified herein several key presenting risk factors for EFI recurrence: men without atopy, smokers, overweight BMI range, and lower income range. Improving GI follow-ups in patients presenting with these risk factors will reduce EoE-related EFI recurrence.

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