December 14, 2011 by dailybolusoflr
Esophageal Foreign Bodies- Food
* While esophageal foriegn bodies come in diverse shapes and sizes, foreign bodies related to food are more predictable. Poorly chewed meat and dried bread are the most commonly cited foods involved.
* Unlike non-food foreign bodies which tend to get stuck at the narrow points of the esophagus (the proximal esophagus at the level of the cricopharyngeal muscle and thoracic inlet; the midesophagus at the level of the aortic arch and carina; the distal esophagus just proximal to the esophagogastric junction), food bolus impactions get stuck at the level of the underlying esophageal pathology, as this is the most common etiology for the impaction
* Schatzki rings (lower esophageal ring) and peptic strictures (related to reflux) are the most common etiologies
* Rare presentations can be related to esophageal cancer, but these patients tend to present with escalating symptoms of solid and then liquid dysphagia
* Patients with dentures are also at higher risk, due to the difficulty in sensing how small a piece of food is when chewed
* For patients with complete obstructions, who are unable to tolerate any po and are spitting out their saliva, attempts can be made to pass assist the food in passing by administering glucagon, which acts by lowering the smooth muscle tone at the lower esophageal sphincter without inhibiting normal esophageal peristalsis. Complications include vomiting, which anectodally has been noted to occur often and potentially limit its use.
* Prolonged pressure on the esophagus can lead to perforation, but this is uncommon. Patients with prolonged food impactions should go straight to endoscopy
* Endoscopy is the preferred removal strategy for all food bolus impactions that are not expeditiously relieved
Ref: Gastrointestinal Endoscopy Clinics of North America 2007. 17: 361-382