What medication can be given to relieve an esophageal food bolus obstruction?

From the Guidelines

There is no medication that can reliably dissolve or unblock a food bolus stuck in the esophagus, and the most effective treatment is an endoscopic procedure performed by a gastroenterologist. If you have a food impaction, you should seek immediate medical attention at an emergency department. Healthcare providers may attempt to relax the esophagus using glucagon (1-2 mg intravenously), which can help in some cases by relaxing smooth muscle, but its effectiveness is limited and variable, as noted in various studies 1.

Key Considerations

• Carbonated beverages, which some people try at home, have little evidence supporting their use, and attempting to "wait it out" or force the food down with more food or liquid can be dangerous and may lead to complications such as aspiration, perforation, or damage to the esophagus.
• The British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition joint consensus guidelines recommend urgent referral of patients with food bolus obstruction to gastroenterology for endoscopic intervention to treat the food bolus and diagnose EoE if present 1.
• The World Journal of Emergency Surgery guidelines recommend emergent flexible endoscopy for sharp-pointed objects, batteries, magnets, and for foreign bodies inducing complete esophageal obstruction, and urgent (< 24 h) flexible endoscopy for other esophageal foreign bodies without complete obstruction 1.

Treatment Approach

• Endoscopic procedure is the most effective treatment for food impaction, where a gastroenterologist can directly visualize and remove the stuck food.
• Gently pushing the bolus into the stomach is recommended for the treatment of esophageal food bolus impaction, and if this procedure is not successful, retrieval should be considered 1.
• If you're experiencing drooling, inability to swallow saliva, severe chest pain, or difficulty breathing, these are signs of a serious impaction requiring immediate medical intervention.

From the FDA Drug Label

Glucagon for Injection is a prescription medicine used: • to treat very low blood sugar (severe hypoglycemia) in people with diabetes mellitus • to stop movement in the intestines in people receiving radiology exams.

The medication that can be given to relieve an esophageal food bolus obstruction is not explicitly mentioned in the provided drug labels. However, glucagon (IV) is sometimes used off-label for this purpose, but this use is not directly supported by the provided drug label information 2.

From the Research

Medication for Esophageal Food Bolus Obstruction

• Glucagon has been used to relieve esophageal food bolus obstruction, as it relaxes the lower esophageal sphincter 3, 4, 5, 6
• The effectiveness of glucagon varies, with some studies showing success in relieving food impactions 3, 5, while others found no evidence of its effectiveness 7
• Other pharmacological agents that have been identified for the management of esophageal food bolus impaction include Buscopan, nitrates, calcium channel blockers, and papaveretum 6
• Non-medicinal agents such as water, effervescent agents, and papain have also been used, although the use of papain is now considered obsolete 6

Predictors of Response to Glucagon

• The type of food ingested, with meat being less likely to respond to glucagon 5
• The presence of esophageal rings or strictures, which can reduce the effectiveness of glucagon 5
• The duration of symptoms, with shorter durations being more likely to resolve spontaneously 5

Safety and Efficacy

• The use of glucagon may be associated with adverse effects such as vomiting, and there is a potential risk of oesophageal perforation 7
• The safety and efficacy of glucagon and other pharmacological agents for the management of esophageal food bolus impaction should be carefully considered, and their use should be tailored to individual patient needs 4, 6