Assessment of the Predictors of Response to Glucagon in the Setting of Acute Esophageal Food Bolus Impaction

Abstract

Esophageal food impactions are frequently seen in endoscopic practice. Glucagon is known to relax the lower esophageal sphincter and has been used with variable success to treat food impactions. We retrieved clinical information of all patients with acute food impactions who attended the emergency room from 1975 to 2000 from the Mayo diagnostic database. Data were abstracted on age, sex, body mass index, relevant prior medical history, food type ingested (meat, bread, vegetable, or other), duration of symptoms at presentation, dosage (in mg) of glucagon, outcome including success of glucagon or spontaneous passage, and endoscopic findings. A total of 222 cases of food impaction were identified, of whom 106 patients (48%) received glucagon, average 1 mg. In glucagon responders, meat was less likely to be the offending food type, accounting for 70% (glucagon responders) vs. 90% (in nonresponders) ( p = 0.03), while responders were less likely to have esophageal rings/strictures detected on subsequent EGD compared with nonresponders, 0% (glucagon responders) vs. 31% (nonresponders) ( p = 0.05). In the patients that did not receive glucagon, spontaneous resolvers had a shorter duration of symptoms at presentation, 3.3 h vs. 12.4 h ( p = 0.07) and were less likely to have an organic esophageal obstruction detected on EGD, 0% vs. 21%. There were no significant differences between the resolvers and nonresolvers in terms of age, gender, BMI, and prior medical history. Conservative management of acute food bolus obstruction, either with or without glucagon, is most successful in the absence of a fixed esophageal obstruction. An impacted meat bolus is more likely to require intervention for removal than other food types. These clinical predictors should be considered before administration of glucagon.

The management of oesophageal soft food bolus obstruction: a systematic review

“…12 In the second study, only 10 of 106 patients given glucagon and 20 of 116 given no medication disimpacted without further intervention. 13 The results suggest that administration of glucagon is no more effective in relieving OSFBO than when no medication is given.…”

“…25 It has not been shown to be effective in treating oesophageal coins in children 26 but it has been used in the management of OSFBO. [11][12][13] A comprehensive search revealed a randomised controlled trial finding no significant difference when comparing glucagon combined with diazepam against placebo for treating OSFBO 11 and two studies investigating 92 12 and 222 13 cases of OSFBO. In the first study, all 92 were given glucagon and 30 disimpacted without surgery.…”

“…> (oesophagus OR esophagus) AND (cola OR coke OR coca-cola OR effervescent OR carbonated OR gas forming) -this yielded four retrospective cohort studies [6][7][8][9] and one case report; 10 > (oesophagus OR esophagus) AND glucagon -this yielded one randomised controlled trial 11 and two further studies; 12,13 Buscopan (+/-fluids only) (7) Spontaneous disimpactation (n=11) …”

Intravenous Glucagon in Food Impaction?Use It or Lose It?

“…Sodeman et al [18] also noted that in approximately 20% of those who received glucagon, a second dose was administered after lack of initial response. Two patients received a third dose of glucagon.…”

“…In a case-control study, Sodeman et al [18] evaluated the potential clinical predictors for response to glucagon in patients with acute esophageal food impaction. Charts of patients seen at the emergency room between 1975 and 2000 for food bolus obstruction were reviewed.…”