{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:47:02Z","timestamp":1760060822604,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Objectives: The COVID-19 pandemic caused significant disruptions in healthcare services. Foreign body impactions (FBIs), with Eosinophilic Esophagitis (EoE) being one of the leading underlying causes in adults, are some of the most common emergencies and often require endoscopy. The study assesses the impact of COVID-19 on the incidence and outcomes of foreign body impactions (FBIs) requiring endoscopy at Canadian tertiary centres in a single city. Methods: Patients presenting to tertiary care hospital emergency departments in Calgary (March 2019\u2013Feb 2022) for FBI were identified using the AACRS (Alberta Ambulatory Care Reporting System) database using International Classification of Disease (ICD-9 and ICD-10) codes (T178, T181) and provincial diagnostic codes (935.1, 530.4) for a foreign body in the esophagus (530.13 and K20.0). One-way ANOVA (SPSS\u00ae 27.0) analyzed incidence and disease progression across Pre-COVID-19 and COVID-19 years. Results: 759 patients were included in the analysis (274 Pre-COVID-19 (PC: March 2019\u2013Feb 2020), 234 COVID-19 Year 1 (CY1: March 2020\u2013Feb 2021), and 251 COVID-19 Year 2 (CY2: March 2021\u2013Feb 2022)). The mean age remained consistent, with two-thirds being male. Food was the predominant type of FBI (&gt;90%). The incidence of new EoE in EDs declined from PC (60.9%) to CY1 (47.4%) (p &lt; 0.001), while endoscopic resolution remained &gt;96%. Follow-up endoscopies in outpatient settings remained stable (~60%). Non-EoE causes of FBI, including esophagitis and cancer, increased in CY2. The mean ED length of stay rose in CY2, but this was not statistically significant (p = 0.06). Conclusions: This study highlights the resilience of emergent endoscopic care in Calgary during COVID, despite a decline in new EoE diagnoses, which might be due to access barriers.<\/jats:p>","DOI":"10.3390\/jcm14196704","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:48:37Z","timestamp":1758635317000},"page":"6704","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating Care Amid Crisis: The Impact of the COVID-19 Pandemic on Eosinophilic Esophagitis Management in Canada"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4741-3542","authenticated-orcid":false,"given":"Sunil","family":"Samnani","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9409-8283","authenticated-orcid":false,"given":"Muhammad Anas","family":"Fazal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, AB T6G 2X8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystyna","family":"Pokraka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5254-7173","authenticated-orcid":false,"given":"Joel","family":"David","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher N.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Buresi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothy Y.","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4487-3420","authenticated-orcid":false,"given":"Matthew","family":"Woo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4698-9948","authenticated-orcid":false,"given":"Christopher","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milli","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","unstructured":"World Health Organization (2020). Coronavirus Disease (COVID-2019) Situation Reports."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.dsx.2020.06.042","article-title":"Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals","volume":"14","author":"Chudasama","year":"2020","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1056\/NEJMc2009166","article-title":"Reduced rate of hospital admissions for ACS during COVID-19 outbreak in Northern Italy","volume":"383","author":"Angelini","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/S1470-2045(20)30265-5","article-title":"Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands","volume":"21","author":"Dinmohamed","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e007274","DOI":"10.1161\/CIRCHEARTFAILURE.120.007274","article-title":"Incidence of new-onset and worsening heart failure before and after the COVID-19 epidemic lockdown in Denmark: A nationwide cohort study","volume":"13","author":"Andersson","year":"2020","journal-title":"Circ. Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.cardfail.2020.05.005","article-title":"Reductions in heart failure hospitalizations during the COVID-19 pandemic","volume":"26","author":"Hall","year":"2020","journal-title":"J. Card. Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106120","DOI":"10.1016\/j.rmed.2020.106120","article-title":"Disproportionate decline in admissions for exacerbated COPD during the COVID-19 pandemic","volume":"191","author":"Berghaus","year":"2022","journal-title":"Respir. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1056\/NEJMc2014816","article-title":"Collateral effect of COVID-19 on stroke evaluation in the United States","volume":"383","author":"Kansagra","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s11469-020-00270-8","article-title":"The Fear of COVID-19 Scale: Development and Initial Validation","volume":"20","author":"Ahorsu","year":"2022","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1200\/GO.20.00172","article-title":"Perspective of oncology patients during COVID-19 pandemic: A prospective observational study from India","volume":"6","author":"Ghosh","year":"2020","journal-title":"JCO Glob. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1053\/j.gastro.2020.05.005","article-title":"Declining cirrhosis hospitalizations in the wake of the COVID-19 pandemic: A national cohort study","volume":"159","author":"Mahmud","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2022942","DOI":"10.1001\/jamanetworkopen.2020.22942","article-title":"Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US","volume":"3","author":"Pollard","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1170","DOI":"10.1016\/j.cgh.2021.10.030","article-title":"Impact of the COVID-19 pandemic on hospitalizations for alcoholic hepatitis or cirrhosis in Alberta, Canada","volume":"20","author":"Shaheen","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"McDonnell, T., Nicholson, E., Conlon, C., Barrett, M., Cummins, F., Hensey, C., and McAuliffe, E. (2020). Assessing the impact of COVID-19 public health stages on paediatric emergency attendance. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186719"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1097\/PG9.0000000000000168","article-title":"Epidemiology of Pediatric Foreign Body Ingestions Amidst the Coronavirus 2019 Pandemic at a Tertiary Care Children\u2019s Hospital","volume":"3","author":"Klein","year":"2022","journal-title":"Jpgn Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e001042","DOI":"10.1136\/bmjpo-2021-001042","article-title":"Foreign body ingestion during the COVID-19 pandemic: A retrospective single centre review","volume":"5","author":"Festa","year":"2021","journal-title":"BMJ Paediatr. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s00464-006-9004-z","article-title":"Upper GI foreign body","volume":"21","author":"Conway","year":"2007","journal-title":"Surg. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.emc.2011.01.009","article-title":"Foreign bodies in the gastrointestinal tract and anorectal emergencies","volume":"29","author":"Anderson","year":"2011","journal-title":"Emerg. Med. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/j.1368-5031.2006.00709.x","article-title":"A review of gastrointestinal foreign bodies","volume":"60","author":"Ayantunde","year":"2006","journal-title":"Int. J. Clin. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1016\/j.gie.2010.11.010","article-title":"Management of ingested foreign bodies and food impactions","volume":"73","author":"Ikenberry","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/S0016-5107(02)70407-0","article-title":"Guideline for the management of ingested foreign bodies","volume":"55","author":"Eisen","year":"2002","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1136\/flgastro-2019-101176","article-title":"Recognising eosinophilic oesophagitis as a cause of food bolus obstruction","volume":"11","author":"Ntuli","year":"2020","journal-title":"Frontline Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.gie.2013.10.027","article-title":"A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease","volume":"79","author":"Dellon","year":"2014","journal-title":"Gastrointest. Endosc."},{"key":"ref_25","unstructured":"(2024, November 01). Review of Alberta\u2019s COVID-19 pandemic response: March 1 to October 12, 2020\u2014Final report to the Government of Alberta. Available online: https:\/\/www.alberta.ca\/system\/files\/custom_downloaded_images\/health-alberta-covid-19-pandemic-response-review-final-report.pdf."},{"key":"ref_26","unstructured":"(2023, January 23). COVID-19 Alberta Statistics. Available online: www.alberta.ca."},{"key":"ref_27","unstructured":"Government of Alberta (2020). COVID-19 Alberta Statistics."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e20181988","DOI":"10.1542\/peds.2018-1988","article-title":"Foreign-body ingestions of young children treated in US emergency departments: 1995\u20132015","volume":"143","author":"McAdams","year":"2019","journal-title":"Pediatrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.jacc.2020.06.039","article-title":"Management and Outcomes of Patients with STEMI During the COVID-19 Pandemic in China","volume":"76","author":"Xiang","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4103\/JETS.JETS_137_20","article-title":"How a Pandemic Changes Trauma: Epidemiology and Management of Trauma Admissions in the UK during COVID-19 Lockdown","volume":"14","author":"Dass","year":"2021","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1001\/jamaoncol.2021.0884","article-title":"Association of Cancer Screening Deficit in the United States with the COVID-19 Pandemic","volume":"7","author":"Chen","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e2138038","DOI":"10.1001\/jamanetworkopen.2021.38038","article-title":"Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic","volume":"4","author":"Mattingly","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1038\/s41467-024-45720-2","article-title":"Inequalities in healthcare use during the COVID-19 pandemic","volume":"15","author":"Frey","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.cgh.2009.08.030","article-title":"Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease","volume":"7","author":"Dellon","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2500\/aap.2023.44.230031","article-title":"Diagnosis of eosinophilic esophagitis in patients with dysphagia during the Coronavirus Disease 2019 (COVID-19) pandemic","volume":"44","author":"Brennan","year":"2023","journal-title":"Allergy Asthma Proc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1111\/jgh.15132","article-title":"A snapshot of urgent upper gastrointestinal endoscopy care during the COVID-19 outbreak in Italy","volume":"35","author":"Lucidi","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1080\/00365521.2020.1782466","article-title":"The impact of covid-19 pandemic on urgent endoscopy in Italy: A nation-wide multicenter study","volume":"55","author":"Salerno","year":"2020","journal-title":"Scand. J. Gastroenterol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6704\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:42Z","timestamp":1760035662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":37,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196704"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196704","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}