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

Abstract

A food bolus obstruction of the oesophagus represents a potentially serious medical problem. It is generally agreed that sharp objects becoming lodged in the oesophagus or objects with a corrosive capacity (eg batteries) should be removed urgently.1 However, the management of oesophageal soft food bolus obstruction (OSFBO) is less clear. The aim of treatment is to prevent the occurrence of potentially serious complications of bolus obstruction, including perforation and mediastinitis. These complications may occur due to mucosal ischaemia resulting from prolonged impaction or iatrogenically during surgical removal.2 In many cases, therefore, the aim of treatment is initially to manage the patient medically to encourage resolution of the obstruction.The management of patients with OSFBO frequently involves a variety of specialties, either individually or in combination. These include the emergency care, general surgery and ENT teams. Currently, however, there is no recognised guidance regarding which medications are efficacious in the resolution of OSFBO. Furthermore, the timing of administration of any medical or surgical treatment is often based entirely on clinical judgement. The aim of this study was to perform a literature review regarding the management of OSFBO. MethodsA review of the literature was performed to evaluate the published evidence regarding pharmacological and surgical treatment of OSFBO. The Singleton Hospital library information department undertook searches of the Cochrane Library, the National Center for Biotechnology Information and the US National Library of Medicine resources. The following search strategies were used: > (oesophagus OR esophagus) AND buscopan -this yielded one case study 3 and two retrospective cohort studies;4,5 > (oesophagus OR esophagus) AND (cola OR coke OR coca-cola OR effervescent OR carbonated OR gas forming) -this yielded four retrospective cohort studies 6-9 and one case report; 10 > (oesophagus OR esophagus) AND glucagon -this yielded one randomised controlled trial 11 and two further studies; RESULTSThis systematic review of the management of OSFBO shows no evidence that any medical intervention is more effective than a 'watch and wait' policy in enabling spontaneous disimpaction. Furthermore, the use of hyoscine butylbromide for OSFBO probably stems from a misquoted textbook. Surgical removal of an OSFBO is effective but not without potential risk. There is some evidence to support surgical intervention within 24 hours to prevent complications deriving from the initial obstruction. CONCLUSIONS There is a need for large double-blind, randomised, placebo controlled trials of drugs used in the medical management of OSFBO. Until the results from such trials are available, the treatment of OSFBO will remain based on inconsistent clinical judgement.

Unlocking opportunities in food design for infants, children, and the elderly: Understanding milestones in chewing and swallowing across the lifespan for new innovations

“…However, faster mastication does not result in more efficient or better bolus preparation for swallowing. Insufficiently chewed food can obstruct the oesophagus requiring emergency surgical removal (Leopard, Fishpool, & Winter, ). Jalabert‐Malbos, Mishellany‐Dutour, Woda, and Peyron () demonstrated that food is swallowed safely when particle sizes are reduced to ∼2mm and that even soft foods require 14–20 masticatory cycles to produce particles of this size.…”

Impactación alimentaria: Reporte de 2 casos y revisión de la literatura

“…Para el manejo, la elección es el estudio endoscópico de manera urgente y se considera que el tiempo máximo para la realización del estudio es de 12-24 h posteriores al evento; el retraso en la realización favorece la compresión de la mucosa esofágica y como consecuencia la isquemia, ulceración y aumento del riesgo de perforación esofágica 1,6 . Respecto al manejo médico, existen múltiples reportes donde se ha evaluado el uso de glucagón, tabletas efervescentes, refresco de cola, benzodiacepinas, hioscina y enzimas proteolíticas con resultados variables en el éxito de estas técnicas 7,8 . En un estudio con 213 casos de impactación Impactación alimentaria 5…”

Pharmacological Management of Esophageal Food Bolus Impaction

“…With the diversity in the types of treatments available for impacted food bolus, there is yet no proven superiority for any particular agent over another, based on randomized clinical trials [55]. However, with the variety of agents discussed and with the availability of appropriate evidence, medical treatment could be used with caution among the various treatment armamentariums currently available for treating patients with acute esophageal food impaction.…”