Acute food bolus impaction: aetiology and management

Abstract

A prospective study into the aetiology of acute food bolus obstruction (AFBO) was carried out on 17 consecutive patients who presented with this complaint. There were nine males and eight females. Twelve patients (71 per cent) had symptoms of oesophageal disease and 10 patients (59 per cent) had prior food bolus obstruction. Investigations included endoscopy, barium swallow, oesophageal pH and manometry studies. Evidence of oesophageal pathology was found in 12/14 (86 per cent) of patients investigated. No patients had malignancy and the most common abnormality, gastroesophageal reflux (GOR) was found in eight out of 14 (57 per cent) of cases. Oesophageal dysmotility was seen in five out of 12 (42 per cent) patients who had manometric studies.With such a high incidence of recurrence of AFBO, we suggest that patients with this condition be investigated to exclude malignancy and to identify benign oesophageal pathology using techniques such as oesophageal pH and manometry. Appropriate treatment of oesophageal disease may help prevent recurrence of this distressing condition.

Endoscopic Techniques and Management of Foreign Body Ingestion and Food Bolus Impaction in the Upper Gastrointestinal Tract: A Retrospective Analysis of 139 Cases

“…30,32 Up to 75% to 100% of patients with food impactions are also reported to have esophageal pathology at the time or follow-up endoscopy. 22,33 Furthermore, more than half of the patients with food bolus impactions have abnormal esophageal manometry test. 33 In most patients, if a benign stricture or Schatzki ring is visualized after clearance of the food bolus, the narrowing can be effectively and safely dilated at the time of the same endoscopy.…”

“…22,33 Furthermore, more than half of the patients with food bolus impactions have abnormal esophageal manometry test. 33 In most patients, if a benign stricture or Schatzki ring is visualized after clearance of the food bolus, the narrowing can be effectively and safely dilated at the time of the same endoscopy. An interesting point of our study was that in 3 patients with food bolus impaction, normal endoscopy, esophageal manometry, and 24-hour pH study, and a negative history of atopy, the biopsies from esophagus showed eosinophilic esophagitis.…”

Prevalence of Eosinophilic Esophagitis in Adults With Food Bolus Obstruction of the Esophagus

“…1,2 The obstruction can usually be managed with the flexible endoscope and the use of a variety of endoscopic accessories which are manipulated via the biopsy channel of the endoscope. 2,3 The current recommendation for the management of acute food bolus obstruction by the American Society of Gastrointestinal Endoscopy (ASGE) is extraction with an overtube to protect the airway. 4 ASGE guidelines also suggest advancing the bolus into the stomach under endoscopic visualization and direction.…”

Predictors of Recurrent Ingestion of Gastrointestinal Foreign Bodies

“…Food impactions are often related to the presence of any type of esophageal pathology (15)(16)(17)(18). In the present study, the most common pathology leading to recurrent food impaction was a distal esophageal stricture, usually a reflux-related stricture or ring.…”