Pharmacological Management of Esophageal Food Bolus Impaction

Abstract

Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including “foreign body, esophageal, esophageal bolus and medical” for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction.

Esophageal food impaction with an unexpected meal in an elderly woman

“…Surgery is required in approximately 1 % of the patients. 5,12 Our case demonstrates that, in patients who have a history of dysphagia or underlying esophageal disease, even ordinary solid foods such as single white bean can result in full obstruction of the esophageal lumen and can lead to the EFI. Patient history should be evaluated carefully and the patients should be investigated for an underlying conditions especially in the elderly population who are presdisposed to conditions associated with impaired chewing and swallowing functions.…”

“…On extensive search of PubMed, we found just two case reports of ivermectin-albendazole-induced psychosis; one in a 36-year-old Indian woman 4 and another in a 10-year-old Indian child. 5 In both of these patients, the history of ivermectin-albendazole intake…”

“…Consistently, in a study by Longstreth et al, it was reported that the incidence of EFI increases with age especially in elderly patients. 5,6 One possible risk for the increased incidence in the elderly is impaired chewing and swallowing due to the increased prevalance of a variety of neurological and anatomical co-morbid conditions effecting dentition and both smooth and striated musculature involved in swallowing. [6][7][8] On the other hand there is only one study which included only 14 patients about EFI on geriatric patients in the literatüre.…”

“…Patients with EFI generally present with acute onset symptoms that begin after food ingestion and the most common symptoms include chest pain, dysphagia, emesis, retching, vomiting, coughing, hypersalivation and sensation of choking. 5,12 Correct diagnosis requires a detailed history, chest radiography, and endoscopic examination. Chest radiography usually cannot detect the obstruction itself but it is useful to evaluate a possible esophageal perforation.…”

Oesophageal food bolus impaction in elderly people

“…Medicamentous treatment is also one of the therapeutic options [10]. If spontaneous propulsion of food bolus does not occur, extraction from the oesophagus can be done by the flexible or, preferably, rigid endoscope.…”