[Bolus].

Food bolus impaction can be a manifestation of chronic untreated inflammation in those with underlying eosinophilic esophagitis (EoE). The eosinophil predominant inflammation of the esophagus is associated with a higherprevalenceoffibrosiswhenitremainsundetectedanduntreated.Non-malignantfoodbolusimpactionisstronglyassociatedwithanunderlyingdiagnosisofEoE,butoutsideofgastroenterologyandotheresophagealinterestedspecialiststhereremainspoorunderstandingofhowtodiagnoseandmanagethiscondition. We conducted a retrospective study of patients presenting to a tertiary emergency unit with esophageal food bolus impaction between Novem-ber 2018 and May 2021. Electronic attendance records and the endoscopy database were examined to determine the associations between demograph-ics, comorbidities, endoscopic findings, biopsy findings and follow up. We also evaluated the effect of the pandemic on food bolus management with statistical analysis undertaken using IBM SPSS software. Of the 938 patients who presented to the emergency department with food Our findings highlight significant shortcomings in the management of those presenting emergently with food bolus impaction and possible undiagnosed EoE. There need for clear management pathways to aid risk-stratification, discharge planning and endoscopic practices in the diagnosis of EoE. We therefore propose an algorithm for food bolus management to facilitate early endoscopy, effective diagnosis, and appropriate follow-up, ensuring optimal management for patients with non- malignant dysphagia requiring emergency admission for resolution of food impaction.