Use of gas-forming agents in esophageal food impactions

Zimmers, Tighe; Chan, S.B.; Kouchoukos, Philip L; Mirande, Hector; Noy, Yigal; VanLeuven, Betty

doi:10.1016/s0196-0644(88)80613-9

Cited by 23 publications

(12 citation statements)

References 5 publications

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“…On review of the literature, four retrospective cohort studies [6][7][8][9] and one case report 10 were identified. These studies reported disimpaction rates of 100%, 6 100% 7 100% 10 80% 8 and 65%, 9 with gas forming agents alone.…”

Section: Gas Forming Agentsmentioning

confidence: 99%

“…9 The total literature on the use of effervescents in OSFBO has low patient numbers and the gas forming agent varies in each study. [6][7][8][9] Nevertheless, the results of the studies were positive, with 79% of cases experiencing disimpaction with a gas forming agent alone or with barium for imaging (as described in the case report 10 ). This combination therapy has not been replicated in a larger study.…”

Section: Gas Forming Agentsmentioning

confidence: 99%

“…> (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) …”

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confidence: 99%

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

Leopard

Fishpool

Winter

2011

annals

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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.

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Section: Gas Forming Agentsmentioning

confidence: 99%

Section: Gas Forming Agentsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Leopard

Fishpool

Winter

2011

annals

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“…10 While a small 2019 South African series documented resolution of complete oesophageal obstruction in 13/22 (59%) cases with no adverse events, 11 other studies have reported complications including aspiration and oesophageal tear. 10,12,13 A 2005 review article reported success rate of 80% but a complication rate of 3% which exceeds that for therapeutic endoscopy. Glucagon is a single-chain polypeptide hormone, involved in glucose homeostasis, which also causes relaxation of the lower oesophageal sphincter and distal oesophagus.…”

Section: Discussionmentioning

confidence: 99%

Management of Adults with Acute Oesophageal Soft Food Bolus and Foreign Body Obstructions at Two New Zealand District Health Boards

Hackett

Brownson

Hill

et al. 2021

CEG

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Aim 1. Investigate the characteristics of adult patients presenting with acute oesophageal soft food bolus obstruction (SFBO) and impacted foreign body (IFB) at two New Zealand district health boards (DHBs). 2. Review current management against international guidelines for SFBO and IFB. Methods A multicentre retrospective search of the Provation ® endoscopy database identified patients presenting with acute oesophageal obstruction. Utilising electronic patient records, key data points including patient demographics, risk factors, pre-endoscopic medical therapies utilised, diagnostic radiological investigations performed and endoscopic complications were identified. Key timepoints and delays in the patient’s hospital journey from oesophageal obstruction to therapeutic endoscopy were recorded. The probability of failing to undergo therapeutic endoscopy for SFBO within the timeframes advised in clinical guidelines as a result of a delay in referral to the endoscopy service was calculated. Results Over a cumulative 10.5-year period of data collection, 227 oesophago-gastro-duodenoscopies were performed: 195 SFBO, 16 IFB, 16 no obstruction identified. Median patient age was 57 (15–95) years. 143 male and 84 female patients. Radiographs were performed in 50.9% of uncomplicated SFBO. Pre-endoscopy medical therapies were administered in 41.4% of the cases. Median time delay from onset of obstruction to therapeutic endoscopy varied: SFBO 19h 0min, complete obstruction 17h 45min, impacted batteries 1h 15min, and presumed sharp objects 6h 0min. Three patients presenting with a soft food bolus obstruction failed to undergo therapeutic endoscopy due to a delay in referral to the endoscopy service, probability 0.034 (95% CI 0.012, 0.095). Two patients died of complications secondary to oesophageal obstruction. Discussion Oesophageal obstruction is a common gastroenterological presentation. At two large centres in New Zealand, patients waited considerably longer than the recommended timeframe from obstruction to therapeutic endoscopy. Contributing factors included patient-related delays to presentation, hospital system-related factors and delays in referral for endoscopy contributed to by unnecessary pre-endoscopic medical therapies and radiographic investigations. Education about oesophageal obstruction together with robust local guidelines have potential to reduce delays and length of hospital stay, as well as reduce patient discomfort and complications.

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“…Cola is commonly used in human patients to disintegrate gastric and intestinal phytobezoars and diospyrobezoars (Chung et al 2006;Ladas et al 2013;Iwamuro et al 2015) and is also widely used to resolve oesophageal obstruction caused by any food bolus (Karanjia and Rees 1993;Cotton 1993;Ko and Enns 2008;Ki Hoon et al 2010;Leopard et al 2011;Shafique et al 2013). Disimpaction rates of oesophageal obstructions using carbonated beverages, or other gas forming agents, alone have been reported in people ranging from 65% (Zimmers et al 1988) to 100% (Rice et al 1983;Mohammed and Hegedus 1986;Karanjia and Rees 1993). Gastric phytobezoar resolution using carbonated beverages was achieved in 91.3% of cases in human patients, either as a single treatment, or combined with further endoscopic techniques (Ladas et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Use of a carbonated beverage to disintegrate a phytobezoar obstructing the intrathoracic portion of the oesophagus of a horse

Livesey

Yorke

Parra

et al. 2019

Equine Veterinary Education

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Summary This report describes the treatment of a 17‐year‐old American Quarter Horse gelding for an oesophageal obstruction of approximately 24 h’ duration. An intraluminal oesophageal mass resembling a phytobezoar and located close to the cardia, was observed during endoscopic examination of the oesophagus of a horse showing signs of oesophageal obstruction. An intrathoracic oesophageal diverticulum, filled with fluid, was observed about 40 cm proximal to the obstruction. The end of a nasogastric tube was guided beyond the diverticulum, using gastroscopic observation, so that its tip rested close to the obstruction. The obstruction failed to disintegrate or move into the stomach despite vigorous, prolonged lavage. With the nasogastric tube left in place, and the horse's head elevated, 0.5 L cola was administered adjacent to the obstruction through the nasogastric tube. The head was maintained in the elevated position for an hour, after which time the head was lowered and oesophageal lavage resumed. The nasogastric tube was passed into the stomach within 3 min of re‐instituting lavage. The successful use of a carbonated beverage to treat human patients for oesophageal or gastrointestinal obstruction caused by a phytobezoar is well documented. Carbonated beverages have also been reported to be effective in treating horses for gastric and enteric impactions caused by persimmon seeds. Administering cola into the oesophagus may help resolve oesophageal obstruction of horses caused by a phytobezoar or impacted feed material when horses are refractory to other treatments.

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Use of gas-forming agents in esophageal food impactions

Cited by 23 publications

References 5 publications

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

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

Management of Adults with Acute Oesophageal Soft Food Bolus and Foreign Body Obstructions at Two New Zealand District Health Boards

Use of a carbonated beverage to disintegrate a phytobezoar obstructing the intrathoracic portion of the oesophagus of a horse

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