From the Guidelines
The medical term for when food obstructs the esophagus is called esophageal food impaction or food bolus obstruction. This condition occurs when food becomes lodged in the esophagus, preventing normal swallowing and passage of food to the stomach. Symptoms typically include difficulty swallowing, chest pain, drooling, inability to swallow saliva, and a sensation that something is stuck in the throat or chest. Immediate medical attention is necessary for this condition. Treatment usually involves endoscopic removal of the impacted food by a gastroenterologist, as recommended by the British Society of Gastroenterology 1.
Key Considerations
- Food bolus obstruction is a common presentation of eosinophilic oesophagitis (EoE), with 46% of patients with food bolus obstruction having histological evidence of EoE 1.
- The GDG recommends urgent referral of patients with food bolus obstruction to gastroenterology for endoscopic intervention to treat the food bolus and diagnose EoE if present 1.
- Oesophageal biopsies should be taken at index endoscopy in patients with food bolus obstruction to diagnose eosinophilic oesophagitis, with a strong level of recommendation and 100% level of agreement 1.
- After spontaneous resolution of food bolus obstruction, patients should be booked for an endoscopy and outpatient review to identify and treat any underlying condition and prevent recurrence 1.
Management and Prevention
- While waiting for medical help, patients should avoid drinking or eating as this may worsen the obstruction.
- They should also avoid taking medications that might dissolve in the esophagus and cause irritation.
- Maintenance therapy with topical steroid reduces the risk of recurrent food bolus obstruction, with a moderate level of evidence and strong level of recommendation 1.
- Diagnosing and treating eosinophilic oesophagitis effectively early in its natural history may prevent long-term complications of fibrosis and strictures requiring subsequent endoscopic intervention, although the level of evidence is low and the level of recommendation is weak 1.
From the Research
Definition of Esophageal Food Bolus Impaction
- Esophageal food bolus impaction refers to the obstruction of the esophagus by a food bolus, which can be a medical emergency [(2,3,4,5,6)].
Causes and Risk Factors
- Underlying esophageal pathology, such as esophagitis, strictures, hiatal hernias, and Schatzki's rings, can increase the risk of esophageal food bolus impaction [(2,5)].
- Diabetes mellitus may also be associated with an increased risk of esophageal food bolus impaction 5.
Diagnosis and Treatment
- Diagnosis is typically made using fluoroscopy to confirm the obstruction and determine its location 6.
- Treatment options include intravenous glucagon to relax the esophageal smooth muscle, endoscopic intervention, and fluoroscopy-guided disimpaction [(2,3,4,6)].
Medical Term
- The medical term for esophageal food bolus impaction is "esophageal food bolus impaction" or "esophageal foreign body obstruction" [(2,3,4,5,6)].