All research presented at ACG 2025 is strictly embargoed until 12:00 pm local Arizona Time, which aligns with Pacific Daylight Time (PDT)/3:00 pm ET on Sunday, October 26, 2025.
Oral 46 – Real-World Study of Biopsy Practices During Food Impactions in the Emergency Department: Multi-State GI Practice
Tuesday, October 28, 2025 | 2:15 PM – 2:25 PM PDT | North Ballroom 120BC
Author Insight from Walker D. Redd, MD, MSCR
What’s new here and important for clinicians?
Patients who have not previously been diagnosed with eosinophilic esophagitis (EoE) often present to the Emergency Department with esophageal food impaction (EFI). Performing esophageal biopsies at the time of EFI is recommended to diagnose EoE. We aimed to determine the proportion of patients presenting with EFI in the community setting who had esophageal biopsies performed.
In a database of 143 care centers located in 7 states in the United States, we identified 1,434 patients who had an upper endoscopy for EFI and found that 278 (19%) had esophageal biopsies during that endoscopy. Of the patients who were biopsied, 132 (47%) were diagnosed with EoE. Among the 1,156 (81%) who were not biopsied, only 80 (7%) had a follow-up upper endoscopy within one year.
This is the first study to assess the rate of biopsies at time of EFI in a large, real-world dataset of community practices. Clinicians should remember to perform esophageal biopsies during endoscopy for EFI. Increasing the food impaction rate biopsy rate is an opportunity to reduce the diagnostic delay in EoE and improve the quality of follow-up care.
What do patients need to know?
If patients experience any difficulty swallowing or a sensation of food transiently being stuck in their esophagus, they should seek medical evaluation even if the symptoms are only intermittent or resolve without intervention. If patients experience a persistent sensation of food being stuck in their esophagus, they should immediately go to the Emergency Department (ED). These symptoms always warrant an upper endoscopy with esophageal biopsies to evaluate for eosinophilic esophagitis (EoE) or another esophageal disorder.
When patients with those symptoms are evaluated, they should be aware that esophageal biopsies should be performed. If esophageal biopsies are not performed initially, they should make sure to follow-up so they can undergo another upper endoscopy with esophageal biopsies. Once the biopsies are performed, they should make sure to discuss the results with the gastroenterologist and follow-up in gastroenterology clinic.
Author Contact
Walker D. Redd, MD, MSCR
Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine
Chapel Hill, NC
walker.redd [at] unchealth.unc.edu
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